Healthcare Provider Details

I. General information

NPI: 1487285227
Provider Name (Legal Business Name): CVM OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 ALLEN RD
ALLEN PARK MI
48101-2007
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 900
GREENBELT MD
20770-3504
US

V. Phone/Fax

Practice location:
  • Phone: 301-982-2000
  • Fax:
Mailing address:
  • Phone: 301-982-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAKIA LEWIS
Title or Position: DIRECTOR OF REVENUE CYCLE MNGMNT
Credential:
Phone: 301-982-2000