Individual
MICHAEL GORDON VLIEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
615 E CROSSTOWN PKWY, KALAMAZOO, MI 49001-2501
(269) 553-7077
Mailing address
615 E CROSSTOWN PKWY, KALAMAZOO, MI 49001-2501
(269) 553-7077
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4704306893
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170066253
—
MI
Enumeration date
05/17/2018
Last updated
05/17/2018
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