Provider Demographics
NPI:1013072198
Name:VANDERPLAS, LARRY MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MARVIN
Last Name:VANDERPLAS
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 1:3600 CAPITAL AVE SW
Mailing Address - Street 2:STE 203
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9393
Mailing Address - Country:US
Mailing Address - Phone:269-979-6383
Mailing Address - Fax:269-979-6381
Practice Address - Street 1:3600 CAPITAL AVE SW
Practice Address - Street 2:STE 203
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9393
Practice Address - Country:US
Practice Address - Phone:269-979-6383
Practice Address - Fax:269-979-6381
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILV045322207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0831635OtherPHP
MI383224959101Medicaid
MILV045322OtherSTATE LICENSE NUMBER
MI3158190Medicaid
MILV045322OtherSTATE LICENSE NUMBER
MI0831635OtherPHP
MI1041770001Medicare ID - Type UnspecifiedADMINISTAR