Healthcare Provider Details

I. General information

NPI: 1477351625
Provider Name (Legal Business Name): VMD PRIMARY PROVIDERS EASTERN MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29409 HAGGERTY RD STE 100
NOVI MI
48377-5504
US

IV. Provider business mailing address

29409 HAGGERTY RD STE 100
NOVI MI
48377-5504
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 Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERI SZOKOLAY
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 770-570-0021