Marielle Vandervennen, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301111845 Issued in MI

Practice address

4288 3 Mile Rd NW Ste 1
Grand Rapids, MI 49534-7596

Phone

(616) 458-3677

NPI assigned

May 16, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Abc Pediatrics, PC

  • Pediatrics Physician
  • Walker, MI
  • NPI 1295836096
  NPD (past)

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

{
    "created_epoch": "1494892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1194252676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4288 3 MILE RD NW STE 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495347596",
            "telephone_number": "616-458-3677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4288 3 MILE RD NW STE 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495347596",
            "telephone_number": "616-458-3677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4174 56th St SW",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MI",
            "postal_code": "494182899",
            "country_code": "US",
            "telephone_number": "616-458-3677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERVENNEN",
        "first_name": "MARIELLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-16",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301111845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EPIC",
            "affiliation": "N",
            "address_1": "1234 Napier Ave",
            "city": "Saint Joseph",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490852112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daniel Vandersteen, LMSW
• Jodi Lynn Vandertuig, B.A
• Gilbert J Vanderveen, M.D.
• Madelyn Anne Vanderveen
• Mackenzie Lauren Vandervelde, PA-C
• Judith A Vanderwal, PHD LLP
• Lori Vanderwal
• Lynn Marie Vanderwal, LMSW
• Mary Vanderwal, COTAL, DOR
• David Arthur Vanderwall, M.D.

• Pediatrics Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; 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.