Healthcare Provider Details

I. General information

NPI: 1124049705
Provider Name (Legal Business Name): CAREY MARIE VIGOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 NORWOOD DR
GROSSE POINTE WOODS MI
48236-1745
US

IV. Provider business mailing address

2081 NORWOOD DR
GROSSE POINTE WOODS MI
48236-1745
US

V. Phone/Fax

Practice location:
  • Phone: 810-986-3224
  • Fax: 888-396-3436
Mailing address:
  • Phone: 810-986-3224
  • Fax: 888-396-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number4301039392
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301039392
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number4301039392
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301039392
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4301039392
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301039392
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number4301039392
License Number StateMI
# 8
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301039392
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: