Provider Demographics
NPI:1013984442
Name:VANDENHOVEN, MICHELE DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DENISE
Last Name:VANDENHOVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST. RM 2532
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-558-8054
Mailing Address - Fax:909-558-0187
Practice Address - Street 1:11234 ANDERSON ST.
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-558-8054
Practice Address - Fax:909-558-0187
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA36210207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8227845Medicaid
WAGAB04324Medicare UPIN
WA8227845Medicaid