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Individual

DR. MICHAEL C VANTUYL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
615 FAIRHURST ST, STERLING, CO 80751-4523
(970) 526-5555
Mailing address
4180 GLENCLIFF AVENUE, KINGMAN, AZ 86401

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
16303
NV
2085R0001X
Radiation Oncology Physician
2010005862
MO
2085R0001X
Radiation Oncology Physician
Primary
9833
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1134261902
BCBS OF AZ
AZ
05
226346
AZ
01
5193524
AETNA PROVIDER #
AZ
Enumeration date
02/12/2007
Last updated
08/01/2017
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