Healthcare Provider Details

I. General information

NPI: 1699874701
Provider Name (Legal Business Name): MEDICAL AMBULATORY SERVICES FOR HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 E MILLER RD
LANSING MI
48911-5312
US

IV. Provider business mailing address

PO BOX 27547
LANSING MI
48909-0547
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-7566
  • Fax: 517-882-5822
Mailing address:
  • Phone: 517-882-3318
  • Fax: 517-882-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD A. VARTANIAN
Title or Position: CEO
Credential:
Phone: 517-882-3318