Provider Demographics
NPI:1386223816
Name:VANDERBERG, JULIE JEANNINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:JEANNINE
Last Name:VANDERBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-391-1680
Mailing Address - Fax:616-391-3674
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-391-1680
Practice Address - Fax:616-391-3674
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351048225207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine