Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101010489 | MI |
NPI | 1093755209 |
---|---|
Provider Name | John G Vanderford |
First Address | Birmingham, MI 48009-1960 |
Second Address | Southfield, MI 48075-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 02/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113374659 | (05) | MI |
114298954 | (05) | MI |
114357957 | (05) | MI |
5101010489 | MEDICAL LICENSE (01) | MI |
F81513 | (02) | MI |
JV010489 | BC/BS OF MICHIGAN (01) | MI |