David Vandam LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704115131 Issued in MI

Legal business name

DAVID VANDAM LLC

Practice address

5130 Coolidge Hwy
Suite 120
Royal Oak, MI 48073-1001

Phone

(248) 658-0878

Fax

(248) 435-0930

NPI assigned

Aug 2, 2013

Organization subpart

No

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

Authorized official

Name

David Van Dam, CRNA

Title

Owner

Phone

(248) 421-5876

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1375401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384128000000",
    "number": "1417389396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6985 MILLER DR",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480924725",
            "telephone_number": "586-264-3500",
            "fax_number": "586-264-3495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 COOLIDGE HWY",
            "address_2": "SUITE 120",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480731001",
            "telephone_number": "248-658-0878",
            "fax_number": "248-435-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID VANDAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-02",
        "last_updated": "2013-11-11",
        "status": "A",
        "authorized_official_last_name": "VAN DAM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-421-5876",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704115131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Certified Registered Nurse Anesthetist in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2013; 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.