JOHN R VYDARENY MD PC (NPI# 1255502605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255502605 |
| Entity Type | Organization |
| Organization Name | JOHN R VYDARENY MD PC |
| Practice Address |
1900 Wealthy St Se Grand Rapids MI 49506-2969 |
| Practice Telephone | 6164591144 |
| Practice Fax Number | 6164593594 |
| Mailing Telephone | 6164591144 |
| Mailing Fax Number | 6164593594 |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-04-17 |
| Authorized Official Name | DR. JOHN R VYDARENY (OWNER) |
| Authorized Official Telephone | 6164591144 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | JV028722 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1075285 | 05 |
| Street Address |
1900 WEALTHY ST SE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49506-2969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902890437 | David D Hamm | Internal Medicine | 1900 Wealthy St Se, Ste 220, Grand Rapids, MI 49506-2969 | 2005-09-12 |
| 1376085191 | Douglas Rau | Registered Nurse | 1900 Wealthy St Se, Suite 290, Grand Rapids, MI 49506-2969 | 2016-11-10 |
| 1568910602 | Jeffrey David Ryan-stout | Physician Assistant | 1900 Wealthy St Se, 290, Grand Rapids, MI 49506-2969 | 2016-09-19 |
| 1437494317 | Sylvia Anne Malcore | Psychologist | 1900 Wealthy St Se, Suite 290, Grand Rapids, MI 49506-2969 | 2012-12-04 |
| 1730443466 | Christa Anne Rector | Physical Medicine & Rehabilitation | 1900 Wealthy St Se, Suite 290, Grand Rapids, MI 49506-2969 | 2012-06-27 |
| 1720354723 | Patrick Ryan Mullan | Physical Medicine & Rehabilitation | 1900 Wealthy St Se, Ste 290, Grand Rapids, MI 49506-2969 | 2012-03-24 |
| 1154699593 | Grand Rapids Cardiology | Clinic/Center | 1900 Wealthy St Se, Grand Rapids, MI 49506-2969 | 2011-12-13 |
| 1861787475 | Ryan Keith Conway | Surgery | 1900 Wealthy St Se, Suite 180, Grand Rapids, MI 49506-2969 | 2011-06-10 |
| 1861701047 | Spectrum Health Primary Care Partners | Internal Medicine | 1900 Wealthy St Se, Grand Rapids, MI 49506-2969 | 2010-10-05 |
| 1730409178 | Gabriel Enrique Gallardo | Surgery | 1900 Wealthy St Se, Suite 180, Grand Rapids, MI 49506-2969 | 2010-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356954705 | Mckenna Shank | Technician | 1409 E Beltline Ave Se, Grand Rapids, MI 49506 | 2020-08-26 |
| 1750917969 | Meghan Elizabeth Southwell | Social Worker | Counseling Center of West Michigan, 360 East Beltline Ave Ne Suite 100, Grand Rapids, MI 49506 | 2020-03-19 |
| 1356876536 | Lisa Finkbeiner | Chiropractor | 1324 Lake Dr Se Ste 1, Grand Rapids, MI 49506 | 2017-04-26 |
| 1447622964 | Ashley Robinson | Rehabilitation Practitioner | 1490 East Beltline Ave, Grand Rapids, MI 49506 | 2015-10-23 |
| 1770951584 | Stuart Segal | Behavioral Analyst | 1415 Wealthy St Se Apt 312, Grand Rapids, MI 49506 | 2015-09-10 |
| 1922476373 | Elizabeth Taylor | Nurse Practitioner | 2255 Wealthy Dr., Grand Rapids, MI 49506 | 2015-09-02 |
| 1780066092 | Carole Walters Counseling | Social Worker | 959 Wealthy St. Se, Grand Rapids, MI 49506 | 2015-06-23 |
| 1053792697 | Rosemary F. Trimpe | Social Worker | 4255 Kalamazoo Se, Grand Rapids, MI 49506 | 2015-06-09 |
| 1164809919 | Gary James | Rehabilitation Practitioner | 1490 E. Beltline Se, Grand Rapids, MI 49506 | 2015-04-30 |
| 1275925315 | Paul Cole | Counselor | 1101 Ball Ave. .se., Grand Rapids, MI 49506 | 2015-02-26 |
| Find all providers in zip 49506 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003460874 | Derm Institute of West Michigan Plc | Dermatology | 6750 Kalamazoo Ave, Suites C & D, Grand Rapids, MI 49508 | 2019-07-30 |
| 1306289574 | Nicholas Michael Bontumasi | Dermatology | 4362 Cascade Road Se, Grand Rapids, MI 49546-3631 | 2013-04-08 |
| 1821350745 | Kristi B Hawley | Dermatology | 6750 Kalamazoo Ave Se Ste C, Grand Rapids, MI 49508-7897 | 2012-06-15 |
| 1437380102 | Adam D Asarch | Dermatology | 4362 Cascade Rd Se, Suite 206, Grand Rapids, MI 49546-3600 | 2009-07-29 |
| 1588783419 | Dara Spearman | Dermatology | 4352 Cascade Road, Suite 206, Grand Rapids, MI 49546-3631 | 2007-03-29 |
| 1962595199 | Howard Alan Beadner | Dermatology | 2124 Woodcliff Ave. Se, Grand Rapids, MI 49546-5711 | 2006-10-02 |
| 1508960253 | Robert W Stokes | Dermatology | 1815 Breton Rd Se, Suite C1, Grand Rapids, MI 49506 | 2006-09-12 |
| 1649260688 | Richard J Ashack | Dermatology | 1740 E Paris Ave Se, Grand Rapids, MI 49546-6204 | 2005-10-21 |
| 1073976338 | Kurt Ashack | Dermatology | 1740 E Paris Ave Se, Grand Rapids, MI 49546-6204 | 2016-04-03 |
| 1376924902 | David Oberlin | Dermatology | 4362 Cascade Rd Se Ste 206, Grand Rapids, MI 49546 | 2015-06-09 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49506 |
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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.