Healthcare Provider Details

I. General information

NPI: 1235144940
Provider Name (Legal Business Name): DAVID NELSON VIGOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N CENTER ST
LOWELL MI
49331-1212
US

IV. Provider business mailing address

5938 BUTTONWOOD DR
HASLETT MI
48840-9757
US

V. Phone/Fax

Practice location:
  • Phone: 616-897-8473
  • Fax: 616-897-0081
Mailing address:
  • Phone: 517-339-6405
  • Fax: 517-339-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301051646
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4301051646
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301051646
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: