Healthcare Provider Details

I. General information

NPI: 1073681219
Provider Name (Legal Business Name): OWOSSO SURGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W KING ST SUITE M
OWOSSO MI
48867-2100
US

IV. Provider business mailing address

802 W KING ST SUITE M
OWOSSO MI
48867-2100
US

V. Phone/Fax

Practice location:
  • Phone: 989-725-9846
  • Fax: 989-725-5009
Mailing address:
  • Phone: 989-725-9846
  • Fax: 989-725-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJV041531
License Number StateMI

VIII. Authorized Official

Name: DR. J M VACHHANI
Title or Position: PRESIDENT
Credential: MD
Phone: 989-725-9846