Individual
JON VANDERVLIET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2006 HOGBACK RD, SUITE 5A, ANN ARBOR, MI 48105-9750
(734) 786-2317
(734) 786-4977
Mailing address
2006 HOGBACK RD, SUITE 5A, ANN ARBOR, MI 48105-9750
(734) 786-2317
(734) 786-4977
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
4301092851
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366603318
—
MI
01
—
4301092851
MICHIGAN LICENSE
MI
01
—
H17604112
MEDICARE PTAN
MI
Enumeration date
06/23/2008
Last updated
05/06/2013
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