Healthcare Provider Details

I. General information

NPI: 1033240163
Provider Name (Legal Business Name): VERNOR MEDICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 W VERNOR HWY
DETROIT MI
48209-2157
US

IV. Provider business mailing address

PO BOX 251927
WEST BLOOMFIELD MI
48325-1927
US

V. Phone/Fax

Practice location:
  • Phone: 313-841-0395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301061931
License Number StateMI

VIII. Authorized Official

Name: NORBERTO ALLENDE
Title or Position: PRESIDENT
Credential:
Phone: 313-841-0395