Healthcare Provider Details

I. General information

NPI: 1225701881
Provider Name (Legal Business Name): VIOS FERTILITY INSTITUTE MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26400 W 12 MILE RD STE 140
SOUTHFIELD MI
48034-1753
US

IV. Provider business mailing address

26400 W 12 MILE RD STE 140
SOUTHFIELD MI
48034-1753
US

V. Phone/Fax

Practice location:
  • Phone: 866-658-8214
  • Fax:
Mailing address:
  • Phone: 866-658-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATRINA MARSHALL
Title or Position: DIR INS CRED & PAYOR CONTRACTS
Credential:
Phone: 773-435-9036