Healthcare Provider Details

I. General information

NPI: 1164873691
Provider Name (Legal Business Name): VPS OF MI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 W 13 MILE RD STE 100
FARMINGTON HILLS MI
48334-2172
US

IV. Provider business mailing address

31500 W 13 MILE RD STE 100
FARMINGTON HILLS MI
48334-2172
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 Number4704278319
License Number StateMI

VIII. Authorized Official

Name: PAYAL SHAH
Title or Position: OWNER
Credential: NP
Phone: 734-772-4722