Healthcare Provider Details

I. General information

NPI: 1073230876
Provider Name (Legal Business Name): VITALITY VISITING PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29217 FORD RD STE 109
GARDEN CITY MI
48135-2890
US

IV. Provider business mailing address

4007 CARPENTER RD # 391
YPSILANTI MI
48197-9644
US

V. Phone/Fax

Practice location:
  • Phone: 248-862-5311
  • Fax: 248-671-0175
Mailing address:
  • Phone: 248-862-5311
  • Fax: 248-671-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: VARSHA BALDRIDGE
Title or Position: OWNER
Credential:
Phone: 248-862-5311