VANDYKE MEDICAL CLINIC MANAGEMENT CORP (NPI# 1174632087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174632087 |
| Entity Type | Organization |
| Organization Name | VANDYKE MEDICAL CLINIC MANAGEMENT CORP |
| Practice Address |
19431 Van Dyke St Detroit MI 48234-3323 |
| Practice Telephone | 3138932010 |
| Practice Fax Number | 3138933308 |
| Mailing Telephone | 3138932010 |
| Mailing Fax Number | 3138933308 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-12-01 |
| Authorized Official Name | DR. ERNEST A MULLEN (PRESIDENT) |
| Authorized Official Telephone | 3138932010 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
4301081357 | MI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS GROUP PIN | 080H249740 | 01 |
| MI | 4796189 TYPE 10 | 05 |
| Street Address |
19431 VAN DYKE ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48234-3323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447653977 | Ernest Mullen Md PC | Clinic/Center | 19431 Van Dyke St, Detroit, MI 48234-3393 | 2014-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205332483 | Bryce Xavier Bredell | Student in an Organized Health Care Education/Training Program | 6071 E Outer Dr, Detroit, MI 48234 | 2018-04-05 |
| 1538668595 | Constance Durden | Social Worker | 19940 Conant Suite B, Detroit, MI 48234 | 2018-02-06 |
| 1891217717 | Donald Williams | Case Manager/Care Coordinator | 19133 Hasse, Detroit, MI 48234 | 2017-07-12 |
| 1063865830 | Gloria A. Love | Psychologist | 19677 Revere, Detroit, MI 48234 | 2016-07-18 |
| 1972977429 | Conant Garden Dental Center Dds PC | Dentist | 2430 E Seven Mile, Suite 6, Detroit, MI 48234 | 2015-11-20 |
| 1861878787 | Kenyatta Philips | Chore Provider | 20119 Helen St, Detroit, MI - MICHIGAN 48234 | 2015-08-03 |
| 1083977144 | Edward Powell | Counselor | 19436 Packard Street, Detroit, MI 48234 | 2012-06-22 |
| 1487931325 | Sonia Renee George | Case Manager/Care Coordinator | 8331 Yolanda St., Detroit, MI 48234 | 2011-11-07 |
| 1851682215 | Detroit Rescue Mission Ministries | Substance Abuse Rehabilitation Facility | 19211 Anglin, Detroit, MI 48234 | 2011-04-20 |
| 1558662742 | Tenille Daniel | Home Health | 17210 Runyon, Detroit, MI 48234 | 2010-11-04 |
| Find all providers in zip 48234 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
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| 1487280681 | Aml Medical Pllc | Clinic/Center | 16584 Westbrook St, Detroit, MI 48219-3870 | 2020-03-19 |
| 1144414970 | Amediquest Health Services | Clinic/Center | 8112 Puritan St, Detroit, MI 48238-1139 | 2007-09-05 |
| 1124630579 | All Star Medical Care Pllc | Clinic/Center | 16800 Greenfield Rd, Detroit, MI 48235-3703 | 2020-08-18 |
| 1679856561 | Paramount Medical Services Plc | Clinic/Center | 19940 Conant St, Ste B, Detroit, MI 48234-1335 | 2011-09-27 |
| 1790098069 | Sierra Medical Associates | Clinic/Center | 2141 E Jefferson Ave, Detroit, MI 48207-4128 | 2010-07-15 |
| 1528210069 | Concentra Health Services, Inc. | Clinic/Center | 2151 East Jefferson Avenue, Detroit, MI 48207-4161 | 2008-10-15 |
| 1407066277 | Medical Resource Group | Clinic/Center | 4777 E Outer Dr, Detroit, MI 48234-3241 | 2007-05-23 |
| 1669694899 | Rosemond Chiropractic Health Center, Inc | Clinic/Center | 17701 Schoolcraft St, Detroit, MI 48227-1347 | 2007-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447883053 | Fenton Massage Company | Clinic/Center | 1250 N Leroy St, Fenton, MI 48430-2760 | 2020-02-21 |
| 1275097487 | Harmony Family Center LLC | Clinic/Center | 50 Filer St Ste 324, Manistee, MI 49660-2727 | 2019-01-22 |
| 1619477866 | Nichole Sandoval | Clinic/Center | 1427 Pingree Ave, Lincoln Park, MI 48146-2094 | 2018-02-14 |
| 1457867574 | Physicians Technology, LLC | Clinic/Center | 23 E Front St Ste 200, Monroe, MI 48161-2210 | 2017-12-27 |
| 1497264022 | Vietmdnet | Clinic/Center | 10948 Thornberry Way, Zeeland, MI 49464-7905 | 2017-09-27 |
| 1033634688 | In His Hands Family Chiropractic, Pllc | Clinic/Center | 5236 Dumond Ct, Lansing, MI 48917-6001 | 2017-08-04 |
| 1063952166 | On-demand Scanning LLC | Clinic/Center | 171 Blanche Dr, Troy, MI 48098-2934 | 2017-03-08 |
| 1982146098 | John Patrick Basler | Clinic/Center | 1006 19th St, Bay City, MI 48708-7348 | 2016-11-07 |
| 1235588716 | Carson Consulting Group | Clinic/Center | 577 N Lamkin Rd, Harbor Springs, MI 49740-8102 | 2016-06-06 |
| 1205205481 | Care Crest | Clinic/Center | 15365 Hill Ct, Roseville, MI 48066-3119 | 2015-09-17 |
| Find all providers with the same taxonomy | ||||
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| 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.