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Individual

DR. SCOTT LESLIE VANDEVORDE

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
8957 OTTOGAN ST, HOLLAND, MI 49423-9044
(616) 748-9025
(616) 748-9124
Mailing address
430 E 8TH ST, PMB 182, HOLLAND, MI 49423-3751
(616) 748-9025
(616) 748-9124

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
5901001567
MI
213E00000X
Podiatrist
Primary
SV001569
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4857059590
BCBS
MI
Enumeration date
10/19/2005
Last updated
07/08/2007
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