MARK VANDERMYDE

PORTAGE, MI
NPI1568543502
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: MI  5601003052)
Enumeration Date2006-10-18
Last Update Date2007-07-08
Business Address
-- MARK VANDERMYDE
7901 ANGLING RD
PORTAGE, MI 49024-0714
Phone number: 269-324-8405
Mailing Address
-- MARK VANDERMYDE
5943 STADIUM DR SUITE 3
KALAMAZOO, MI 49009-3016
Phone number:
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