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NPI Code Detail

MEDICARE: MR. KURT VANDERVEEN PA-C

MEDICARE: MR. KURT VANDERVEEN PA-C
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
1207N00000XDermatology Physician5601004356MI
2363A00000XPhysician Assistant5601004356MI

General Provider Information

NPI Number : 1407941396
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KURT VANDERVEEN PA-C
Provider Business Mailing Address
First Line : 3434 RIVERTOWN POINT CT SW
Second Line :
City : GRANDVILLE
State : MI
Zip : 49418-3076
Country : US
Telephone Number : 616-257-3344
Fax Number : 616-257-1491
Provider Business Practice Location Address
First Line : 3434 RIVERTOWN POINT CT SW
Second Line :
City : GRANDVILLE
State : MI
Zip : 49418-3076
Country : US
Telephone Number : 616-257-3344
Fax Number : 616-257-1491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 03/02/2023

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Directions to “ MR. KURT VANDERVEEN PA-C” Practice Location

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