Provider Demographics
NPI:1457315095
Name:VANDEN BOSCH, JOSEPH YARED (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:YARED
Last Name:VANDEN BOSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 COMMERCE AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4124
Mailing Address - Country:US
Mailing Address - Phone:616-940-0660
Mailing Address - Fax:616-940-1965
Practice Address - Street 1:4100 LAKE DR SE
Practice Address - Street 2:SUITE 305
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-285-1377
Practice Address - Fax:616-285-1006
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066019208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000197359804OtherUNITED HEALTH CARE
7000027001OtherPRIORITY HEALTH MEDICAID
175884OtherUS DEPARTMENT OF LABOR
MI4532331-10Medicaid
7944423OtherAETNA
19944OtherHEALTH PLAN OF MICHIGAN
2011679OtherPHYSICIANS HEALTH PLAN
050076520OtherRAILROAD MEDICARE
MI550411009OtherBCBSM
7000027001OtherPRIORITY HEALTH
MI4552933-10Medicaid
5211544OtherCIGNA
2011679OtherPHYSICIANS HEALTH PLAN
5211544OtherCIGNA