Provider Demographics
NPI:1841204690
Name:VAN ANDEL, CAROL COX (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:COX
Last Name:VAN ANDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:39211 LANSE CREUSE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2070
Mailing Address - Country:US
Mailing Address - Phone:586-954-2761
Mailing Address - Fax:586-203-1261
Practice Address - Street 1:37040 GARFIELD RD
Practice Address - Street 2:STE T-5
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3646
Practice Address - Country:US
Practice Address - Phone:586-203-1260
Practice Address - Fax:586-203-1261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010499492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2605041432OtherBLUE CROSS
MI2873850Medicaid
05041439261Medicare ID - Type Unspecified
MA2605041432OtherBLUE CROSS