Individual
KENNETH M VANDERVELDE JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7775 ANGLING RD, PORTAGE, MI 49024
(269) 321-9970
(269) 321-9972
Mailing address
7775 ANGLING RD, PORTAGE, MI 49024
(269) 321-9970
(269) 321-9972
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
KV029466
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1395346
—
MI
Enumeration date
03/10/2006
Last updated
07/08/2007
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