Healthcare Provider Details

I. General information

NPI: 1710370796
Provider Name (Legal Business Name): VISITING PHYSICIANS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2015
Last Update Date: 03/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 CARPENTER ST SUITE 6
DETROIT MI
48212-2784
US

IV. Provider business mailing address

3611 CARPENTER ST SUITE 6
DETROIT MI
48212-2784
US

V. Phone/Fax

Practice location:
  • Phone: 248-509-4070
  • Fax: 248-509-4080
Mailing address:
  • Phone: 248-509-4070
  • Fax: 248-509-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301034247
License Number StateMI

VIII. Authorized Official

Name: JINIT SHAH
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-509-4070