Provider Demographics
NPI:1477619997
Name:VERMEER, BRUCE H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:VERMEER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 HEALTH DR SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9691
Mailing Address - Country:US
Mailing Address - Phone:616-742-1960
Mailing Address - Fax:616-819-2222
Practice Address - Street 1:2093 HEALTH DR SW
Practice Address - Street 2:SUITE 200
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9691
Practice Address - Country:US
Practice Address - Phone:616-742-1960
Practice Address - Fax:616-819-2222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008623103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301008623OtherPSYCHOLOGIST LICENSE
S06470Medicare UPIN
OM55580Medicare ID - Type Unspecified