Healthcare Provider Details

I. General information

NPI: 1639095748
Provider Name (Legal Business Name): VANDYKEHOLDINGSTWENTYTHREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51675 REGENCY CENTER DR
MACOMB MI
48042-4132
US

IV. Provider business mailing address

51675 REGENCY CENTER DR
MACOMB MI
48042-4132
US

V. Phone/Fax

Practice location:
  • Phone: 786-509-5082
  • Fax:
Mailing address:
  • Phone: 786-509-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LOUIS SOKOLOVIC
Title or Position: OWNER
Credential:
Phone: 786-509-5082