Basic Information
| Provider Information | |||||||||
| NPI: | 1831187608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDENBELT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 3175 W PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896673377 | ||||||||
| FaxNumber: | 9896679991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 03/10/2011 | ||||||||
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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 | 207V00000X | 4301029467 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | P75164 | 01 | BLUE CARE NETWORK OF MICH | OTHER | 193892 | 01 | CIGNA | OTHER | 381908328 | 01 | TRICARE | OTHER | 1831187608 | 05 | MI | MEDICAID | 4532190 | 01 | MOLINA HEALTH CARE OF MI | OTHER | 0998824 | 01 | HEALTHPLUS OF MICHIGAN | OTHER | 108779 | 01 | GREAT LAKES HEALTH PLAN | OTHER | 110 | 01 | COMMUNITY CHOICE OF MI | OTHER | 4005484 | 01 | AETNA | OTHER | 700G361110 | 01 | BCBS OF MICHIGAN | OTHER |