Healthcare Provider Details

I. General information

NPI: 1679670749
Provider Name (Legal Business Name): THOMAS VANWINGEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S JACKSON ST
SPRING LAKE MI
49456-2095
US

IV. Provider business mailing address

109 S JACKSON ST
SPRING LAKE MI
49456-2095
US

V. Phone/Fax

Practice location:
  • Phone: 616-842-7406
  • Fax: 616-844-7056
Mailing address:
  • Phone: 616-842-7406
  • Fax: 616-844-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301042275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: