Provider Demographics
NPI:1942482641
Name:RONALD VANDERLAAN, MD, PLLC
Entity Type:Organization
Organization Name:RONALD VANDERLAAN, MD, PLLC
Other - Org Name:GREATER CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SZOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-900-9911
Mailing Address - Street 1:655 KENMOOR AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8622
Mailing Address - Country:US
Mailing Address - Phone:616-900-9911
Mailing Address - Fax:616-900-9862
Practice Address - Street 1:655 KENMOOR AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8622
Practice Address - Country:US
Practice Address - Phone:616-900-9911
Practice Address - Fax:616-900-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046234207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942482641Medicaid
0D12046OtherBCBS GROUP PIN