Provider Demographics
NPI:1104821438
Name:VAN ARK, JOSEPH PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:VAN ARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 HARTEL RD
Mailing Address - Street 2:STE 108
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9165
Mailing Address - Country:US
Mailing Address - Phone:517-627-3281
Mailing Address - Fax:517-627-8722
Practice Address - Street 1:11615 HARTEL RD
Practice Address - Street 2:STE 108
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-9165
Practice Address - Country:US
Practice Address - Phone:517-627-3281
Practice Address - Fax:517-627-8722
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01-00164OtherPHYSICIANS HEALTH PLAN
MI5706661OtherAETNA US HEALTHCARE
MI080B37601OtherBCBSM
MI2683874Medicaid
MI5706661OtherAETNA US HEALTHCARE
MI0231002Medicare ID - Type Unspecified