Healthcare Provider Details

I. General information

NPI: 1972251437
Provider Name (Legal Business Name): VMD PRIMARY PROVIDERS EASTERN MICHIGAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
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
60603-4043
US

V. Phone/Fax

Practice location:
  • Phone: 734-224-8317
  • Fax:
Mailing address:
  • Phone: 888-978-1055
  • Fax: 713-981-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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