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NPI Code Detail

MEDICARE: DR. STEPHEN P VANDER ROEST M.D.

MEDICARE: DR. STEPHEN P VANDER ROEST M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician4301068550MI

General Provider Information

NPI Number : 1386627917
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN P VANDER ROEST M.D.
Provider Business Mailing Address
First Line : 1105 6TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-947-0673
Fax Number : 801-840-2847
Provider Business Practice Location Address
First Line : 1105 6TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-947-0673
Fax Number : 801-840-2847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 07/26/2024

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