Healthcare Provider Details

I. General information

NPI: 1962621383
Provider Name (Legal Business Name): NATALIE A VAN VENROOIJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MICHIGAN ST NE, SUITE 3003
GRAND RAPIDS MI
49503-2538
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-2400
  • Fax: 616-267-2401
Mailing address:
  • Phone: 616-486-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301088446
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number4301088446
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: