Provider Demographics
NPI:1184827677
Name:VERHEEK, JOHN THEODORE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THEODORE
Last Name:VERHEEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 WALTHAM DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5636
Mailing Address - Country:US
Mailing Address - Phone:734-994-6640
Mailing Address - Fax:734-994-3758
Practice Address - Street 1:2311 E STADIUM BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4833
Practice Address - Country:US
Practice Address - Phone:734-994-6640
Practice Address - Fax:734-994-3758
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005031103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68OH114280Medicare UPIN
MION60950Medicare ID - Type UnspecifiedMEDICARE