Healthcare Provider Details

I. General information

NPI: 1114901840
Provider Name (Legal Business Name): JAMES A VANHAREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 E PARIS AVE SE
GRAND RAPIDS MI
49546-6139
US

IV. Provider business mailing address

PO BOX 1969
GRAND RAPIDS MI
49501-1969
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-0700
  • Fax:
Mailing address:
  • Phone: 800-968-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4301054556
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number43010545
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: