Provider Demographics
NPI:1285756148
Name:VAN PELT, ANDREA EMMA (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:EMMA
Last Name:VAN PELT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4070 LAKE DRIVE SE SUITE 202
Mailing Address - Street 2:CENTER FOR BREAST & BODY CONTOURING
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-464-4420
Mailing Address - Fax:646-464-4354
Practice Address - Street 1:4070 LAKE DRIVE SE
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-464-4420
Practice Address - Fax:616-464-4354
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010955222086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery