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General NPI Number Information
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NPI Number | 1679512966
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Entity Type | Individual
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Provider Name | ARIE J. VANDERWEIDE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 230 W OAK ST SUITE 201
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City | FREMONT
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State | MI
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Zip | 49412-1575
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Country | US
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Telephone | 231-924-4200
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Fax | 231-924-2001
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Provider Business Mailing Address
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Address Line | 230 W OAK ST SUITE 201
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City | FREMONT
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State | MI
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Zip | 49412-1575
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Country | US
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Telephone | 231-924-4200
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Fax | 231-924-2001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 065627
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License Number State | MI
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