Individual
MR. EVAN REID VANDENBOSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
36622 5 MILE RD, SUITE 101, LIVONIA, MI 48154-1900
(734) 542-0200
Mailing address
36622 5 MILE RD, SUITE 101, LIVONIA, MI 48154-1900
(734) 542-0200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007644
MI
363AS0400X
Surgical Physician Assistant
5601007644
MI
Other
Enumeration date
12/30/2015
Last updated
06/12/2024
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