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General NPI Number Information
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NPI Number | 1053075358
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Entity Type | Organization
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Legal Business Name | EVERT HEALTH, PLLC
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Dates
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Enumeration Date | 10/24/2021
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 1311 HARVARD RD
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City | BERKLEY
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State | MI
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Zip | 48072-1912
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Country | US
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Telephone | 248-736-7553
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Fax |
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Provider Business Mailing Address
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Address Line | 909 E MAPLE ST
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City | HOLLY
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State | MI
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Zip | 48442-1755
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Country | US
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Telephone | 248-820-1712
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Fax | 248-469-0966
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Authorized Official
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Title or Position | OWNER
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Name | MARC VANDER VLIET
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Credential | MD
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Telephone | 313-574-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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