Individual
VAN C. MOMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 5500 AUTO CLUB DRIVE, SUITE 160, DEARBORN, MI 48126
(313) 425-4700
Mailing address
HENRY FORD HEALTH SYSTEM, 5500 AUTO CLUB DRIVE, SUITE 160, DEARBORN, MI 48126
(313) 425-4700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301047888
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175499010
—
MI
01
—
700H262280
BLUE CROSS-BLUE CROSS
—
01
—
VM047888
CHAMPUS-CHAMPUS
—
Enumeration date
01/04/2007
Last updated
03/11/2021
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