Vandyke Medical Clinic Management Corp

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

4301081357 Issued in MI

Legal business name

VANDYKE MEDICAL CLINIC MANAGEMENT CORP

Practice address

19431 Van Dyke St
Detroit, MI 48234-3323

Phone

(313) 893-2010

Fax

(313) 893-3308

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ernest A Mullen, M.D.

Title

President

Phone

(313) 893-2010

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashleigh Alexandria Finazzo, PA

  • Medical Physician Assistant
  • Ferndale, MI
  • NPI 1912394966
  NPD (past)
• Camille Elise Johnson, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Southfield, MI
  • NPI 1558337147
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448928000000",
    "number": "1174632087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19431 VAN DYKE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482343323",
            "telephone_number": "313-893-2010",
            "fax_number": "313-893-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19431 VAN DYKE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482343323",
            "telephone_number": "313-893-2010",
            "fax_number": "313-893-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDYKE MEDICAL CLINIC MANAGEMENT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2015-12-01",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-893-2010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MI",
            "license": "4301081357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4796189 TYPE 10",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP PIN",
            "identifier": "080H249740",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori Vanderwill
• Matthew Vanderwindt, LCSW
• Victoria Vanderziel-Fultz
• Nick Vandiver
• Nathan Vandjelovic
• Carole Vandyke, P.A.
• Karra Ann Vanfleteren, NNP
• Ashley Vang
• Stephen J Vangel, PHD
• Leanne Grace Vangilder, CRNA

• Health Service Clinic/Center in Detroit, MI
• Providers in Detroit, MI by specialty
• Health Service Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.