1861282535 NPI number — DR. VICTORIA JANE VAN DYKE

Table of content: DR. VICTORIA JANE VAN DYKE (NPI 1861282535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861282535 NPI number — DR. VICTORIA JANE VAN DYKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN DYKE
Provider First Name:
VICTORIA
Provider Middle Name:
JANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUELLER
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861282535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15384 MYSTIC CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48170-2788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-759-8897
Provider Business Mailing Address Fax Number:
517-759-8897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 ABBOT RD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-332-0100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2025

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: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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