Provider Demographics
NPI:1164425567
Name:VANWINKLE, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:VANWINKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:6401 PRAIRIE ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7840
Practice Address - Country:US
Practice Address - Phone:231-727-7920
Practice Address - Fax:231-727-7921
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDV053530207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E85423Medicare UPIN