Provider Demographics
NPI:1154361293
Name:VRIELINK, JEFFREY JOHN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:VRIELINK
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 1:6410 ALPINE AVE NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8001
Mailing Address - Country:US
Mailing Address - Phone:616-647-3330
Mailing Address - Fax:616-647-3335
Practice Address - Street 1:6410 ALPINE AVE NW
Practice Address - Street 2:SUITE A
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8001
Practice Address - Country:US
Practice Address - Phone:616-647-3330
Practice Address - Fax:616-647-3335
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010794222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2604112072OtherBC/BS
MI4387867Medicaid
MI2604112072OtherBC/BS
MIH57248Medicare UPIN