Provider Demographics
NPI:1104146075
Name:SANDEN, HOWARD VERNON (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:VERNON
Last Name:SANDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:972 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4861
Mailing Address - Country:US
Mailing Address - Phone:231-798-7653
Mailing Address - Fax:231-798-7653
Practice Address - Street 1:972 RANDALL RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4861
Practice Address - Country:US
Practice Address - Phone:231-798-7653
Practice Address - Fax:231-798-7653
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301023942208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics