Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301042819 | MI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301042819 | MI |
NPI | 1134176415 |
---|---|
Provider Name | Dr. Fred James Vanalstine |
First Address | Muskegon, MI 49443-1847 |
Second Address | Muskegon, MI 49444-1849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134176415 | (05) | MI |
B45679 | (02) |