Healthcare Provider Details

I. General information

NPI: 1730218967
Provider Name (Legal Business Name): TRACEY LYNNE VENNING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S CANTON CENTER RD
CANTON MI
48188-1992
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR STE J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-844-8743
  • Fax: 734-844-8744
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301084094
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: