Healthcare Provider Details

I. General information

NPI: 1114103314
Provider Name (Legal Business Name): FRANCINE LEA VAGOTIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRANCINE LEA VAGOTIS MD

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 CASCADE RD SE STE 130
GRAND RAPIDS MI
49546-3708
US

IV. Provider business mailing address

4940 CASCADE RD SE STE 130
GRAND RAPIDS MI
49546-3708
US

V. Phone/Fax

Practice location:
  • Phone: 616-285-6400
  • Fax: 616-285-0417
Mailing address:
  • Phone: 616-285-6400
  • Fax: 616-285-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036122075
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301052683
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: