Healthcare Provider Details

I. General information

NPI: 1285737379
Provider Name (Legal Business Name): RICHARD E VERMEULEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W COLLEGE AVE
MARQUETTE MI
49855-2705
US

IV. Provider business mailing address

580 W COLLEGE AVE
MARQUETTE MI
49855-2736
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4575
  • Fax:
Mailing address:
  • Phone: 906-225-7160
  • Fax: 906-225-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301407225
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: