Individual
MARK THOMAS VANDER LUGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 EAST MEDICAL CENTER DRIVE, 7TH FLOOR C.S. MOTT CHILDRENS HOSPITAL, ANN ARBOR, MI 48109-4257
(734) 936-9814
Mailing address
3621 SOUTH STATE STREET, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301094130
MI
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
4301094130
MI
2080P0207X
Pediatric Hematology & Oncology Physician
MD446513
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/08/2006
Last updated
08/02/2016
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