Healthcare Provider Details

I. General information

NPI: 1821347741
Provider Name (Legal Business Name): SPRING ARBOR UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 EAST MAIN STREET SPRING ARBOR UNIVERSITY
SPRING ARBOR MI
49283-9701
US

IV. Provider business mailing address

106 EAST MAIN STREET C/O SPRING ARBOR UNIVERSITY
SPRING ARBOR MI
49283-9701
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-6352
  • Fax: 517-750-6625
Mailing address:
  • Phone: 517-750-6352
  • Fax: 517-750-6625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN LEE VANDERHILL
Title or Position: ASSOCIATE V.P. FOR STUDENT DEVELOPM
Credential:
Phone: 517-750-6367