Individual
JAMES MICHAEL VANDAELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
17877 W 14 MILE RD, BEVERLY HILLS, MI 48025
(248) 644-3920
(248) 644-2569
Mailing address
17877 W 14 MILE RD, BEVERLY HILLS, MI 48025-3127
(248) 644-3920
(248) 644-2569
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008593
MI
363AS0400X
Surgical Physician Assistant
018604
NY
363AS0400X
Surgical Physician Assistant
5601008593
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315090542
CONTROLLED SUBSTANCE LICENSE
MI
01
—
5601008593
PHYSICIAN ASSISTANT LICENSE FOR THE STATE OF MICHIGAN
MI
Enumeration date
05/04/2015
Last updated
08/03/2023
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