Organization
JOHN R VYDARENY MD PC
Active
Organization
JOHN R VYDARENY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN R VYDARENY MD (OWNER)
(616) 459-1144
Entity
Organization
Contact information
Practice address
1900 WEALTHY ST SE, GRAND RAPIDS, MI 49506-2969
(616) 459-1144
(616) 459-3594
Mailing address
1900 WEALTHY ST SE, GRAND RAPIDS, MI 49506-2969
(616) 459-1144
(616) 459-3594
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
JV028722
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1075285
—
MI
Enumeration date
03/13/2008
Last updated
04/17/2008
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