Healthcare Provider Details

I. General information

NPI: 1336625540
Provider Name (Legal Business Name): VMD PRIMARY PROVIDERS EASTERN MICHIGAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27275 HAGGERTY RD STE 500
NOVI MI
48377-3635
US

IV. Provider business mailing address

125 S CLARK ST STE 900
CHICAGO IL
60603-5200
US

V. Phone/Fax

Practice location:
  • Phone: 312-465-7900
  • Fax:
Mailing address:
  • Phone: 312-465-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RAGER
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 844-969-0686