MEDICARE: DR. ERIK PAUL VOOGD 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
1	208D00000X	General Practice Physician	A81701	CA
2	208VP0014X	Interventional Pain Medicine Physician	4301110921	MI
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	4301110921	MI

General Provider Information

NPI Number	:	1679552228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIK PAUL VOOGD M.D.

Provider Business Mailing Address
First Line	:	5555 GLENWOOD HILLS PKWY SE STE 2
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-2091
Country	:	US
Telephone Number	:	616-940-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 SHRESTHA DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2171
Country	:	US
Telephone Number	:	989-686-6900
Fax Number	:	989-686-6911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	05/06/2021

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