Healthcare Provider Details

I. General information

NPI: 1356288021
Provider Name (Legal Business Name): VITAL CORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W GRAND RIVER AVE STE A
OKEMOS MI
48864-1604
US

IV. Provider business mailing address

320 GWENDOLYN BLVD
MILFORD MI
48381-2312
US

V. Phone/Fax

Practice location:
  • Phone: 248-980-7414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SAMIA IMRAN
Title or Position: CONSULTANT/BILLING
Credential:
Phone: 248-980-7414