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Organization
SOUTHSIDE MEDICAL CENTER INC
Active
Organization
SOUTHSIDE MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS VANDERJACT DO (OWNER)
(517) 913-3888
Entity
Organization
Contact information
Practice address
5525 S MARTIN LUTHER KING JR BLVD, LANSING, MI 48911-3546
(517) 913-3888
Mailing address
5525 S MARTIN LUTHER KING JR BLVD, LANSING, MI 48911-3546
(517) 913-3888
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730121880
INDIVIDUAL NPI
MI
Enumeration date
11/10/2014
Last updated
11/10/2014
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