Healthcare Provider Details

I. General information

NPI: 1194202234
Provider Name (Legal Business Name): MVP ENDOVASCULAR CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2018
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22720 MICHIGAN AVE STE 300
DEARBORN MI
48124-2035
US

IV. Provider business mailing address

22720 MICHIGAN AVE STE 300
DEARBORN MI
48124-2035
US

V. Phone/Fax

Practice location:
  • Phone: 313-791-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY ALLEN REICHMAN
Title or Position: CONSULTING MANAGER
Credential:
Phone: 513-697-8557