Provider Demographics
NPI:1437141330
Name:VANCE, MARLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:ASPLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:300 N PATTERSON RD
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8041
Practice Address - Country:US
Practice Address - Phone:231-832-7170
Practice Address - Fax:231-832-9554
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM75620064Medicare ID - Type Unspecified
MI431924010Medicaid
MIH22438Medicare UPIN