Individual
ETHAN S. VANTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
3537 W FRONT ST, SUITE I, TRAVERSE CITY, MI 49684-7943
(231) 935-8950
(231) 935-8868
Mailing address
3537 W FRONT ST, SUITE I, TRAVERSE CITY, MI 49684-7943
(231) 935-8950
(231) 935-8868
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301076955
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4298892
—
MI
Enumeration date
08/16/2005
Last updated
10/20/2011
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