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NPI Code Detail

MEDICARE: JULIA DIANE VANDERKOLK MD

MEDICARE: JULIA DIANE VANDERKOLK 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
1390200000XStudent in an Organized Health Care Education/Training Program4351055622MI

General Provider Information

NPI Number : 1861239121
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA DIANE VANDERKOLK MD
Provider Business Mailing Address
First Line : 1200 E HOSPITAL DR. D3230
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109
Country : US
Telephone Number : 734-647-1774
Fax Number :
Provider Business Practice Location Address
First Line : 8001 CHALLIS RD
Second Line :
City : BRIGHTON
State : MI
Zip : 48116-7446
Country : US
Telephone Number : 734-539-5080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2024
Last Update Date : 06/04/2026

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