Healthcare Provider Details

I. General information

NPI: 1083447551
Provider Name (Legal Business Name): VITALITY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 BLOSSOM DR
ANN ARBOR MI
48103-6024
US

IV. Provider business mailing address

432 BLOSSOM DR
ANN ARBOR MI
48103-6024
US

V. Phone/Fax

Practice location:
  • Phone: 248-722-3736
  • Fax:
Mailing address:
  • Phone: 248-722-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHNIWAZ LABANA
Title or Position: OWNER
Credential: MD, MBA
Phone: 248-722-3736