Individual
DAVID VANDENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4967 CROOKS RD, SUITE 130, TROY, MI 48098-5801
(248) 952-1601
(248) 952-0192
Mailing address
4967 CROOKS RD, SUITE 130, TROY, MI 48098-5801
(248) 952-1601
(248) 952-0192
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301051758
MI
208M00000X
Hospitalist Physician
4301051758
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4846610
—
MI
01
—
DV051758
BCBSM
MI
Enumeration date
09/08/2005
Last updated
10/31/2007
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