Individual
DR. MICHAEL JAMES VREDEVOOGD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
36385 HARPER AVE, CLINTON TOWNSHIP, MI 48035-4635
(586) 741-0295
(586) 792-5190
Mailing address
50081 SASS RD, CHESTERFIELD, MI 48047-1946
(586) 530-7919
(586) 792-5190
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
63010006531
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680EO1478
BLUE CROSS BLUE SHIELD
MI
Enumeration date
01/09/2007
Last updated
07/08/2007
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