Organization
VANDYKE MEDICAL CLINIC MANAGEMENT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST A MULLEN M.D. (PRESIDENT)
(313) 893-2010
Entity
Organization
Contact information
Practice address
19431 VAN DYKE ST, DETROIT, MI 48234-3323
(313) 893-2010
(313) 893-3308
Mailing address
19431 VAN DYKE ST, DETROIT, MI 48234-3323
(313) 893-2010
(313) 893-3308
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
4301081357
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080H249740
BLUE CROSS GROUP PIN
MI
05
—
4796189 TYPE 10
—
MI
Enumeration date
08/30/2006
Last updated
12/01/2015
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