Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | DV053530 | MI |
NPI | 1164425567 |
---|---|
Provider Name | Dr. David A Vanwinkle |
First Address | Muskegon, MI 49443-1848 |
Second Address | Muskegon, MI 49444-7840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 03/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E85423 | (02) |