Individual
DEREK VANDEWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
110 S MADISON ST, ADRIAN, MI 49221-2575
(517) 265-5161
Mailing address
6789 MARSHALL ST, CANTON, MI 48187-1660
(734) 558-9299
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/25/2024
Last updated
03/25/2024
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