Individual
RONALD VANDERLAAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
655 KENMOOR AVE SE STE 101, GRAND RAPIDS, MI 49546-8622
(616) 900-9911
(616) 900-9862
Mailing address
655 KENMOOR AVE SE STE 101, GRAND RAPIDS, MI 49546-8622
(616) 900-9911
(616) 900-9862
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301046234
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447299599
TRICARE
MI
05
—
1447299599
—
MI
01
—
2939555
CIGNA
MI
01
—
MEMBER PTAN P0061774
RAILROAD MEDICARE
MI
Enumeration date
06/05/2006
Last updated
12/17/2021
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