Provider Demographics
NPI:1053955633
Name:VANDEBUNTE, DAVID G (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:VANDEBUNTE
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1206 RUNAWAY BAY DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8743
Mailing Address - Country:US
Mailing Address - Phone:616-717-2503
Mailing Address - Fax:
Practice Address - Street 1:616 MEIJER ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-8457
Practice Address - Country:US
Practice Address - Phone:517-541-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601009742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant