Provider Demographics
NPI:1285656660
Name:VANDER HILL, SCOTT D (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:VANDER HILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 LINDEN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1879
Practice Address - Country:US
Practice Address - Phone:231-796-3200
Practice Address - Fax:231-796-5562
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3056968Medicaid
MI0M01220011Medicare ID - Type Unspecified
MI3056968Medicaid