Healthcare Provider Details

I. General information

NPI: 1932622578
Provider Name (Legal Business Name): MARIA VERMEULEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA GLIGOR DO

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 SIMPSON DR MBBD D3230
ANN ARBOR MI
48109
US

IV. Provider business mailing address

41521 W 11 MILE RD
NOVI MI
48375-1803
US

V. Phone/Fax

Practice location:
  • Phone: 734-539-5080
  • Fax:
Mailing address:
  • Phone: 248-299-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5151015376
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: