Individual
KEVIN L VANALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15100 WHITTAKER WAY, GRAND HAVEN, MI 49417-8696
(616) 935-6200
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301053221
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0804103371
BCBS
MI
01
—
1598712390
GROUP NPI
MI
05
—
4770001
—
MI
05
—
4770010
—
MI
05
—
4770020
—
MI
05
—
4773881
—
MI
05
—
4773952
—
MI
Enumeration date
05/17/2006
Last updated
02/16/2021
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