Individual
DR. JOHN R. VYDARENY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
833 MICHIGAN ST NE, SUITE 102, GRAND RAPIDS, MI 49503-3523
(616) 459-1144
(616) 459-0313
Mailing address
833 MICHIGAN ST NE, SUITE 102, GRAND RAPIDS, MI 49503-3523
(616) 459-1144
(616) 459-0313
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
JV028722
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1075285
—
MI
Enumeration date
11/08/2005
Last updated
03/16/2015
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