Provider Demographics
NPI:1285998377
Name:VANHOOSER, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:VANHOOSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 W ANN ARBOR TRL
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6204
Mailing Address - Country:US
Mailing Address - Phone:734-398-7800
Mailing Address - Fax:734-455-5219
Practice Address - Street 1:990 W ANN ARBOR TRL
Practice Address - Street 2:SUITE 208
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6204
Practice Address - Country:US
Practice Address - Phone:734-398-7800
Practice Address - Fax:734-455-5219
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101580207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics