Individual
JEFFREY VANDERBILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
69011 WILDWOOD DR, WHITE PIGEON, MI 49099-7727
(269) 483-9991
Mailing address
69011 WILDWOOD DR, WHITE PIGEON, MI 49099-7727
(269) 483-9991
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4704211765
MI
363L00000X
Nurse Practitioner
Primary
4704211765
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568542082
—
MI
Enumeration date
10/17/2006
Last updated
06/11/2009
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