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NPI Code Detail

MEDICARE: DR. DENNIS SETH VANWORMER D.O.

MEDICARE: DR. DENNIS SETH VANWORMER D.O.
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
1207Q00000XFamily Medicine Physician5101009001MI

General Provider Information

NPI Number : 1336129568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENNIS SETH VANWORMER D.O.
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9090 S RODGERS CT SE STE A
Second Line :
City : CALEDONIA
State : MI
Zip : 49316-8052
Country : US
Telephone Number : 616-891-0422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 05/20/2025

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