DR. RUDY JEROME VERVAEKE (NPI# 1922108927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922108927 |
| Entity Type | Individual |
| Full Name | DR. RUDY JEROME VERVAEKE |
| Credential | M.D. |
| Practice Address |
21420 Harper Ave Suite 2 Saint Clair Shores MI 48080-3607 |
| Practice Telephone | 5867757400 |
| Practice Fax Number | 5867750091 |
| Mailing Telephone | 5867757400 |
| Mailing Fax Number | 5867750091 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-11-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
4301044898 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | COMMERCIAL | 352263519 | 01 |
| MI | 4842512-10 | 05 | |
| MA | BLUE CROSS BLUE SHIELD | 1105018171 | 01 |
| Street Address |
21420 HARPER AVE SUITE 2 |
| City | SAINT CLAIR SHORES |
| State | MI |
| Zip Code | 48080-3607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942300884 | Southeastern Michigan Medical Consultants PC | Internal Medicine | 21420 Harper Ave, Suite 2, Saint Clair Shores, MI 48080-3607 | 2006-09-22 |
| 1558461426 | Bharat Kumar Patel | Internal Medicine | 21420 Harper Ave, Suite 2, Saint Clair Shores, MI 48080-3607 | 2006-09-22 |
| 1083714976 | Bharat Patel M.d. PC | Internal Medicine | 21420 Harper Ave, Suite 2, Saint Clair Shores, MI 48080-3607 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508482084 | Farrah Aleema Rajab | Family Medicine | 24911 Little Mack Avenue, Suite C, St. Clair Shores, MI 48080 | 2020-06-22 |
| 1558986141 | Julia Anastazja Krakowska | Family Medicine | 24911 Little Mack, Suite C, St. Clair Shores, MI 48080 | 2020-06-10 |
| 1972073567 | Joyce Stepnak | Social Worker | 19611 E. 8 Mile Rd, Scs, MI 48080 | 2018-11-27 |
| 1487134177 | Bonnie Girson | Social Worker | 23409 Jefferson Ave Ste 100, Saint Clair Shores, MI 48080 | 2018-08-21 |
| 1609309913 | Park Pharmacy Scs LLC | Pharmacy | 20225 E 9 Mile Rd Ste 120a, Saint Clair Shores, MI 48080 | 2017-04-05 |
| 1730564055 | Mary Rose Giroux | Psychologist | 22516 Overlake St, St. Clair Shores, MI 48080 | 2015-07-28 |
| 1962882910 | Ali Tarif Bazzy | Family Medicine | 20225 E 9 Mile Rd Ste A, Saint Clair Shores, MI 48080 | 2015-06-04 |
| 1497156228 | Kelly Zalewski | Social Worker | 24631 Jefferson Ave, Saint Clair Shores, MI 48080 | 2014-09-11 |
| 1669871364 | Mallory Margret Gordon | Psychologist | 19900 E. 10 Mile Rd., Ste. 102, Saint Clair Shores, MI 48080 | 2014-08-19 |
| 1932549375 | Alexander Peter Bill | Otolaryngology | 22631 Greater Mack Ave Ste 200, Saint Clair Shores, MI 48080 | 2013-06-30 |
| Find all providers in zip 48080 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548325186 | Rudy J Vervaeke Md Plc | Internal Medicine | 24211 Little Mack Ave, Saint Clair Shores, MI 48080-1151 | 2006-12-26 |
| 1942300884 | Southeastern Michigan Medical Consultants PC | Internal Medicine | 21420 Harper Ave, Suite 2, Saint Clair Shores, MI 48080-3607 | 2006-09-22 |
| 1558461426 | Bharat Kumar Patel | Internal Medicine | 21420 Harper Ave, Suite 2, Saint Clair Shores, MI 48080-3607 | 2006-09-22 |
| 1083714976 | Bharat Patel M.d. PC | Internal Medicine | 21420 Harper Ave, Suite 2, Saint Clair Shores, MI 48080-3607 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013367473 | East & West Physicians PC | Internal Medicine | 20905 Greenfield Rd Ste 608, Southfield, MI 48075-5355 | 2016-06-16 |
| 1033445861 | Ayad M George, Pllc | Internal Medicine | 2132 Cedar St, Holt, MI 48842-1458 | 2009-10-29 |
| 1588821433 | West Michigan Addiction Consultants, PC | Internal Medicine | 3001 Fuller Ave Ne, Suite 1, Grand Rapids, MI 49505-3247 | 2008-05-19 |
| 1730727850 | Dearborn Pain Center Pllc | Internal Medicine | 624 E 9 Mile Rd, Hazel Park, MI 48030-1842 | 2019-12-19 |
| 1063069359 | Faster Care Connor Creek, Pllc | Internal Medicine | 4777 E Outer Dr, Detroit, MI 48234-3241 | 2019-08-21 |
| 1356869572 | America Recovery Center, Pllc | Internal Medicine | 20217 Ann Arbor Trl, Dearborn Heights, MI 48127-2692 | 2017-09-07 |
| 1356793954 | Iha Health Services Corporation | Internal Medicine | 5333 Mcauley Dr Rm 5011, Ypsilanti, MI 48197-1003 | 2016-07-07 |
| 1770967226 | Newhorizon Center LLC | Internal Medicine | 555 W Crosstown Pkwy, Suite 201, Kalamazoo, MI 49008-1999 | 2015-07-15 |
| 1942618228 | Changes | Internal Medicine | 19940 Conant St, Detroit, MI 48234-1494 | 2014-07-30 |
| 1033434253 | Elizabeth Bulat | Internal Medicine | 37595 7 Mile Rd, # 240, Livonia, MI 48152-1003 | 2010-03-30 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLAIR SHORES |
| Zip Code | 48080 |
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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.