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Individual
DR. PETER S VANDEMARK
Active
Individual
DR. PETER S VANDEMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301038966
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0540004
BLUE CROSS BLUE SHIELD
MI
01
—
110154022
PALMETTO GBA RAILROAD MR
MI
05
—
3377875
—
MI
Enumeration date
11/07/2005
Last updated
01/19/2017
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