Individual
CHARLES JAY VANDENBERG IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1293 E PARKDALE AVE, MANISTEE, MI 49660-8904
(231) 398-1840
Mailing address
1391 E PARKDALE AVE, MANISTEE, MI 49660-9352
(231) 398-1760
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2012020880
MO
207R00000X
Internal Medicine Physician
Primary
5101021764
MI
Other
Enumeration date
08/12/2012
Last updated
09/16/2024
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