Individual
DR. MARCIA LYNNE VANDERBROEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3272 WEST RD, TRENTON, MI 48183-2322
(734) 676-7900
(734) 676-0335
Mailing address
3272 WEST RD, TRENTON, MI 48183-2322
(734) 676-7900
(734) 676-0335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101009578
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
383607563
TAX ID
MI
01
—
3927
HAP
MI
05
—
4321696
—
MI
01
—
5820325
BLUE CROSS/BLUE SHIELD
MI
Enumeration date
07/18/2005
Last updated
12/10/2012
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