Healthcare Provider Details

I. General information

NPI: 1114223310
Provider Name (Legal Business Name): VHS PHYSICIANS OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44000 W 12 MILE RD SUITE 211
NOVI MI
48377-2644
US

IV. Provider business mailing address

4675 DEPARTMENT
CAROL STREAM IL
60122-0021
US

V. Phone/Fax

Practice location:
  • Phone: 248-305-8707
  • Fax: 248-305-8709
Mailing address:
  • Phone: 810-720-5715
  • Fax: 810-732-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: BETTY DAVENPORT
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 810-720-5715