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Individual
MICHAEL VAN WYNGARDEN
Active
Individual
MICHAEL VAN WYNGARDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.0007421
CO
363AM0700X
Medical Physician Assistant
Primary
PA223530
OR
Other
Enumeration date
02/23/2021
Last updated
03/11/2025
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