Provider Demographics
NPI:1174500235
Name:VANDERMEER, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:VANDERMEER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:577 MICHIGAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4911
Mailing Address - Country:US
Mailing Address - Phone:616-393-2190
Mailing Address - Fax:616-393-0147
Practice Address - Street 1:577 MICHIGAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4911
Practice Address - Country:US
Practice Address - Phone:616-393-2190
Practice Address - Fax:616-393-0147
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301069337207Y00000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5177345Medicaid
MI5177345Medicaid