Individual
MARY ELIZABETH VAN DER VELDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 647-5299
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301082862
MI
2080P0202X
Pediatric Cardiology Physician
Primary
4301082862
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4560087
—
MI
Enumeration date
08/02/2006
Last updated
07/23/2024
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