KEVIN VANDOKKUMBURG


Address: 350 Lafayette Ave Se, 4th Floor, Grand Rapids, MI 49503-4656
Phone: 6164568515

KEVIN VANDOKKUMBURG (NPI# 1134514490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1134514490
Entity Type Individual
Full Name KEVIN VANDOKKUMBURG
Credential PA-C
Practice Address 350 Lafayette Ave Se
4th Floor
Grand Rapids
MI 49503-4656
Mailing Address 3565 Momentum Pl
Chicago
IL 60689
Practice Telephone 6164568515
Practice Fax Number 6164568208
Mailing Telephone 6164568515
Mailing Fax Number 6164568208
Enumeration Date 2015-04-03
Last Update Date 2015-05-06
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363AM0700X Physician Assistant
Specialization: Medical
5601007350 MI Physician Assistants & Advanced Practice Nursing Providers
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
5601007350 MI Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
MI 1134514490 05

Office Location

Street Address 350 LAFAYETTE AVE SE
4TH FLOOR
City GRAND RAPIDS
State MI
Zip Code 49503-4656

Providers in the same location

NPI Name Taxonomy Address Enumeration
1760481782 Geoffrey A Sandman Orthopaedic Surgery 350 Lafayette Ave Se, 4th Floor, Grand Rapids, MI 49503-4656 2005-07-20
1497205140 Lauren Elizabeth Tweedy Occupational Therapist 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 2016-10-06
1275903163 Jennifer Herrick Specialist/Technologist 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 2015-10-05
1982098356 Amber Wilson Specialist/Technologist 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 2015-03-24
1356730048 Gretchen Shay Goodman Specialist/Technologist 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 2015-01-18
1417380544 Clayton J Jewell Occupational Therapist 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 2013-08-13
1437402542 Mary Free Bed Hospital and Rehabiliation Center Physical Therapist 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 2012-10-26
1689927873 Clarence J Verbrugge Physical Therapist 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 2012-10-25
1083972244 Laura Miersen Physical Therapist 350 Lafayette Ave Se, Suite 500, Grand Rapids, MI 49503-4656 2012-04-25
1881952257 Christopher Marshall Bajema Physical Therapist 350 Lafayette Ave Se, Suite 500, Grand Rapids, MI 49503-4656 2012-04-24
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1801496195 Airway Oxygen, Inc. Durable Medical Equipment & Medical Supplies Lemmen Holton Cancer Pavilion, 145 Michigan St Ne Ste 3400, Grand Rapids, MI 49503 2020-10-27
1730707282 Adriana Molina-schmuker Counselor 901 Eastern Avenue Ne, Grand Rapids, MI 49503 2020-07-10
1477176949 Kimberly Buskirk Specialist 1131 Ionia Ava Nw, Grand Rapids, MI 49503 2020-05-19
1124647805 Jared Host Speech-Language Pathologist Mercy Health Hauenstein Neuroscience Center 220 Cherry, Grand Rapids, MI 49503 2020-04-13
1265061378 Heather Gladfelter Student in an Organized Health Care Education/Training Program 339 Barclay Ave Ne Ste 300, Grand Rapids, MI 49503 2020-04-02
1194368647 Amy Jo Arends Nurse Practitioner 350 Lafayette S.e., Suite 301, Grand Rapids, MI 49503 2019-10-28
1376185199 Beth Arce Occupational Therapist 245 Cherry St Se Suite 302, Grand Rapids, MI 49503 2019-10-14
1295387256 Althea Ziolkowski Licensed Practical Nurse Salvation Army Turning Point Programs, 1215 Fulton St E, Grand Rapids, MI 49503 2019-07-10
1790340719 Heather Anne Fox Occupational Therapist Marywood, 111 Lakeside Dr Ne, Grand Rapids, MI 49503 2019-05-06
1184182883 April L Kaiserlian Social Worker 983 Spaulding Ave Ne, Ada, MI 49503 2019-03-12
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1093028441 Lonna Petronella Van Ast Physician Assistant 1022 Ada Place Dr Se, Grand Rapids, MI 49546-3786 2010-07-14
1285681536 Susan G Laham Physician Assistant 1425 Michigan St Ne, Suite D, Grand Rapids, MI 49503-2027 2006-05-30
1891768065 Paul Loh Physician Assistant 100 Michigan St Ne, Mc 103, Suite 8830, Grand Rapids, MI 49503-2560 2006-02-08
1366439432 Michael Lee Bills Physician Assistant 4100 Lake Dr Se Ste 300, Grand Rapids, MI 49546-8292 2005-10-04
1285633172 Adam J Geller Physician Assistant 1300 Michigan St Ne Ste 200, Grand Rapids, MI 49503-2029 2005-07-21
1649787128 Corey John Koll Physician Assistant 1111 Leffingwell Ave Ne, Grand Rapids, MI 49525-6406 2018-01-05
1811439763 Danielle Susan Douglass Physician Assistant 25 Michigan St Ne, Suite 6100, Grand Rapids, MI 49503-2515 2016-11-09
1982078515 Laura E Stevenson Physician Assistant 1111 Leffingwell Ave Ne, Grand Rapids, MI 49525-6406 2015-11-19
1932570975 Neurosurgery Health Services Plc Physician Assistant 414 Plymouth Ave Ne, Grand Rapids, MI 49505-6038 2015-10-16
1427437177 Ian Gary Mcbain Physician Assistant 221 Michigan St Ne Ste 400, Grand Rapids, MI 49503-2543 2015-05-28
Find all providers in GRAND RAPIDS

Competitor

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City GRAND RAPIDS
Zip Code 49503

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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