Provider Demographics
NPI:1871851105
Name:VANVREEDE, ANTHONY C
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:VANVREEDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 W FRONT ST STE C
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2368
Mailing Address - Country:US
Mailing Address - Phone:231-642-5031
Mailing Address - Fax:231-525-2306
Practice Address - Street 1:1225 W FRONT ST STE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2368
Practice Address - Country:US
Practice Address - Phone:231-642-5031
Practice Address - Fax:231-525-2306
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103521207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology