Healthcare Provider Details

I. General information

NPI: 1285656660
Provider Name (Legal Business Name): SCOTT D VANDER HILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LINDEN ST SUITE 1
BIG RAPIDS MI
49307-1879
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-3200
  • Fax: 231-796-5562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301052874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: