Basic Information
| Provider Information | |||||||||
| NPI: | 1104815851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDUYNE | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1314 S LINDEN RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421700 | ||||||||
| FaxNumber: | 8107204035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301024072 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A75415 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 0802589601 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 252745 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 4385871 | 05 | MI | MEDICAID | 252745 | 01 | MI | HEALTH ADVANTAGE PLAN | OTHER | 4453525 | 01 | MA | AETNA | OTHER | C1677 | 01 | MI | MCARE | OTHER | P00205302/CJ6210 | 01 | MI | METRAHEALTH | OTHER | 0189602 | 01 | MI | HEALTH PLUS | OTHER | 8891888003 | 01 | MI | CIGNA | OTHER |