MARK VANDERMYDE
Physician Assistant
Active
Individual
NPI: 1568543502
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Physician Assistant | 363A00000X | Yes | 5601003052 (MI) |
Frequently Asked Questions
NPI 1568543502 is the National Provider Identifier for MARK VANDERMYDE, a Physician Assistant provider located in Portage, MI. This NPI was enumerated on October 18, 2006.
MARK VANDERMYDE practices at 7901 ANGLING RD, Portage, MI 49024.
Quick Facts
- NPI
- 1568543502
- Type
- Individual
- Enumerated
- Oct 18, 2006
- Last Updated
- Jul 8, 2007
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