1275889446 NPI number — KATE MARIE VANDERHOOF OD

Table of content: KATE MARIE VANDERHOOF OD (NPI 1275889446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275889446 NPI number — KATE MARIE VANDERHOOF OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERHOOF
Provider First Name:
KATE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275889446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 BREWER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48367-4406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-337-4708
Provider Business Mailing Address Fax Number:
586-296-7256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33080 UTICA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRASER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48026-2038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-296-7250
Provider Business Practice Location Address Fax Number:
586-296-7256
Provider Enumeration Date:
07/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901004730 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4901004730 . This is a "STATE OF MICHGIAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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