Individual
LYLE J VANDERSCHAAF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 W MAGNETIC ST, SUITE ER, MARQUETTE, MI 49855-2711
(888) 674-0854
(906) 225-3370
Mailing address
4602 DEPT, CAROL STREAM, IL 60122-0021
(906) 225-4821
(906) 225-4537
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301070441
MI
208D00000X
General Practice Physician
Primary
4301070441
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301070441
MICHIGAN LICENSE #
MI
Enumeration date
12/09/2005
Last updated
07/10/2013
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