Organization
MICHAEL VREDEVOOGD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JAMES VREDEVOOGD (PRESIDENT)
(586) 741-0295
Entity
Organization
Contact information
Practice address
36385 HARPER AVE, CLINTON TOWNSHIP, MI 48035-4635
(586) 741-0295
Mailing address
36385 HARPER AVE, CLINTON TOWNSHIP, MI 48035-4635
(586) 741-0295
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
63010066531
MI
261QM0850X
Adult Mental Health Clinic/Center
63010066531
MI
Other
Enumeration date
11/21/2007
Last updated
11/21/2007
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