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DR. MICHAEL JAMES VREDEVOOGD PH.D.

Clinical Neuropsychologist

Clinton Township, Michigan

Provider NPI: 1205985397

Provider Information:
DR. MICHAEL JAMES VREDEVOOGD PH.D.
Gender: M
Sole Proprietor


Practice Location:
36385 HARPER AVE  CLINTON TOWNSHIP, MI 48035 US
Tel: 586-741-0295  Fax: 586-792-5190

Business Mailing Address:
50081 SASS RD  CHESTERFIELD, MI 48047 US
Tel: 586-530-7919  Fax: 586-792-5190

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
MI63010006531

Other Provider Identifiers:

IssuerNumberStateType
BLUE CROSS BLUE SHIELD680EO1478MI01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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