Healthcare Provider Details

I. General information

NPI: 1821820952
Provider Name (Legal Business Name): VERIFIED PROVIDER SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25880 OUTER DR
LINCOLN PARK MI
48146-1553
US

IV. Provider business mailing address

25880 OUTER DR
LINCOLN PARK MI
48146-1553
US

V. Phone/Fax

Practice location:
  • Phone: 844-509-4070
  • Fax: 800-509-3646
Mailing address:
  • Phone: 844-509-4070
  • Fax: 800-509-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JINIT SHAH
Title or Position: ADMIN
Credential: NP-C
Phone: 734-772-4722