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General NPI Number Information
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NPI Number | 1891725867
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Entity Type | Organization
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Legal Business Name | MICHAEL H. VANDERLICK M.D. APMC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 601 W SAINT MARY BLVD STE. 210
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City | LAFAYETTE
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State | LA
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Zip | 70506-3568
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Country | US
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Telephone | 337-291-1162
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Fax | 337-264-1499
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Provider Business Mailing Address
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Address Line | 601 W SAINT MARY BLVD STE. 210
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City | LAFAYETTE
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State | LA
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Zip | 70506-3568
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Country | US
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Telephone | 337-291-1162
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Fax | 337-264-1499
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Authorized Official
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Title or Position | CHIEF EXECUTOR
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Name | DR. MICHAEL HENRY VANDERLICK
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Credential | M.D.
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Telephone | 337-291-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 14489R
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License Number State | LA
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