Healthcare Provider Details

I. General information

NPI: 1043221435
Provider Name (Legal Business Name): VHS PHYSICIANS OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R STE 708
DETROIT MI
48201
US

IV. Provider business mailing address

4160 JOHN R ST STE 404S
DETROIT MI
48201-2021
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-6034
  • Fax: 313-832-7849
Mailing address:
  • Phone: 248-450-3507
  • Fax: 248-796-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301038283
License Number StateMI

VIII. Authorized Official

Name: AARON W MADDOX
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 313-832-6034