Individual
KEVIN VANDOKKUMBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2144 E PARIS AVE SE STE 240, GRAND RAPIDS, MI 49546-6117
(616) 949-8945
(616) 949-1115
Mailing address
2144 E PARIS AVE SE STE 240, GRAND RAPIDS, MI 49546-6117
(616) 949-8945
(616) 949-1115
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
5601007350
MI
363AS0400X
Surgical Physician Assistant
Primary
5601007350
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134514490
—
MI
Enumeration date
04/03/2015
Last updated
06/12/2023
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