Individual
KEITH CHARLES VANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
3980 JOHN R, DETROIT, MI 48201
(888) 362-2500
Mailing address
3990 JOHN R HAR SURGERY, DETROIT, MI 48201
(313) 745-7237
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601001903
MI
Other
Enumeration date
03/29/2007
Last updated
07/22/2021
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