Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301082862 | MI |
Y | 2080P0202X | Pediatric Cardiologist | 4301082862 | MI |
NPI | 1194732867 |
---|---|
Provider Name | Mary E Van Der Velde |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 29/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4560087 | (05) | MI |
E65988 | (02) |