Healthcare Provider Details

I. General information

NPI: 1861867889
Provider Name (Legal Business Name): VINCENT DECIANTIS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30600 TELEGRAPH RD STE 1160
BINGHAM FARMS MI
48025-4531
US

IV. Provider business mailing address

7240 CHASE OAKS BLVD
PLANO TX
75025-5901
US

V. Phone/Fax

Practice location:
  • Phone: 844-999-0020
  • Fax: 888-926-1121
Mailing address:
  • Phone: 844-999-0020
  • Fax: 214-291-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4704274231
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704274231
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4704274231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: