Healthcare Provider Details

I. General information

NPI: 1508417197
Provider Name (Legal Business Name): VPS OF MI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25880 OUTER DR STE 1
LINCOLN PARK MI
48146-1553
US

IV. Provider business mailing address

25880 OUTER DR STE 1
LINCOLN PARK MI
48146-1553
US

V. Phone/Fax

Practice location:
  • Phone: 248-509-4070
  • Fax: 248-509-4080
Mailing address:
  • Phone: 248-509-4070
  • Fax: 248-509-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAYAL JINIT SHAH
Title or Position: OWNER
Credential: NP-C
Phone: 248-509-4070