Healthcare Provider Details

I. General information

NPI: 1083922389
Provider Name (Legal Business Name): MICHIGAN V & P MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1886 W. AUBURN #300
ROCHESTER HILLS MI
48309
US

IV. Provider business mailing address

1886 W AUBURN RD STE 400
ROCHESTER HILLS MI
48309-3865
US

V. Phone/Fax

Practice location:
  • Phone: 248-290-3111
  • Fax:
Mailing address:
  • Phone: 248-290-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301034670
License Number StateMI

VIII. Authorized Official

Name: DR. NANDA SALEM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 248-290-3111