Healthcare Provider Details

I. General information

NPI: 1710959150
Provider Name (Legal Business Name): VASCULAR SURGERY ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 W BRISTOL RD
FLINT MI
48507-2919
US

IV. Provider business mailing address

5020 W BRISTOL RD
FLINT MI
48507-2919
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-1620
  • Fax: 810-732-8559
Mailing address:
  • Phone: 810-732-1620
  • Fax: 810-732-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH JACOT
Title or Position: BUSINESS ADMINISTRATOR
Credential: MBA
Phone: 810-732-1620