Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4301038153 | MI |
Y | 207PE0004X | Emergency Medical Services | 4301038153 | MI |
N | 207Q00000X | Family Doctor | 4301038153 | MI |
NPI | 1194710111 |
---|---|
Provider Name | Philip Vanlente |
First Address | Grand Rapids, MI 49501-4917 |
Second Address | Grand Rapids, MI 49503-4502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 04/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1443748 | (05) | MI |
B46903 | (02) | MI |
PV038153 | BLUE CROSS BLUE SHIELD (01) |