Provider Demographics
NPI:1770634305
Name:VAN ORT, DEBRA MARY (DO)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARY
Last Name:VAN ORT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8391 COMMERCE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4489
Mailing Address - Country:US
Mailing Address - Phone:248-690-6966
Mailing Address - Fax:248-653-5022
Practice Address - Street 1:8391 COMMERCE RD STE 103
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-690-6966
Practice Address - Fax:248-535-0226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDV009592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI12421OtherMEDICARE
MI0156308105OtherBCBS
MIE37315Medicare UPIN