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NPI Code Detail

MEDICARE: STUART VANDERHEIDE MD

MEDICARE: STUART VANDERHEIDE MD
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
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician4301076690MI
2207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician4301076690MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1930125665OTHERMIRAILROAD MEDICARE

General Provider Information

NPI Number : 1619990819
Entity Type Code : Individual
Provider Name (Legal Business Name) : STUART VANDERHEIDE MD
Provider Business Mailing Address
First Line : PO BOX 1487
Second Line :
City : MUSKEGON
State : MI
Zip : 49443
Country : US
Telephone Number : 616-975-1845
Fax Number : 616-285-0846
Provider Business Practice Location Address
First Line : 2366 OAK VALLEY DR
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-8944
Country : US
Telephone Number : 877-227-8823
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 09/21/2023

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Directions to “ STUART VANDERHEIDE MD” Practice Location

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