Individual
DR. KEITH VANOOSTERHOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 776-0682
(616) 685-1846
Mailing address
1900 44TH ST SE, KENTWOOD, MI 49508-5008
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301042561
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
4301042561
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0801101642
BLUE CROSS PIN
MI
05
—
4854101
—
MI
01
—
80059362
RAILROAD MEDICARE
MI
Enumeration date
06/28/2006
Last updated
03/07/2023
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