Healthcare Provider Details

I. General information

NPI: 1336112937
Provider Name (Legal Business Name): ROBERT VANDERBROOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 BEECH ST SUITE 3200
CLARE MI
48617-1466
US

IV. Provider business mailing address

639 JULIUS ST
CLARE MI
48617-9730
US

V. Phone/Fax

Practice location:
  • Phone: 989-802-5035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301079028
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: