MEDICARE: VICTOR VERMEULEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	35029658	OH

General Provider Information

NPI Number	:	1316240906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR VERMEULEN MD

Provider Business Mailing Address
First Line	:	6171 LAKESHORE DR
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-9139
Country	:	US
Telephone Number	:	616-786-3189
Fax Number	:

Provider Business Practice Location Address
First Line	:	6171 LAKESHORE DR
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-9139
Country	:	US
Telephone Number	:	616-786-3189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	12/21/2010

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Directions to “ VICTOR VERMEULEN MD” Practice Location

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