Healthcare Provider Details

I. General information

NPI: 1104821438
Provider Name (Legal Business Name): JOSEPH PAUL VAN ARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11615 HARTEL RD STE 108
GRAND LEDGE MI
48837-9165
US

IV. Provider business mailing address

11615 HARTEL RD STE 108
GRAND LEDGE MI
48837-9165
US

V. Phone/Fax

Practice location:
  • Phone: 517-627-3281
  • Fax: 517-627-8722
Mailing address:
  • Phone: 517-627-3281
  • Fax: 517-627-8722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301406591
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: