Healthcare Provider Details

I. General information

NPI: 1508160193
Provider Name (Legal Business Name): BIRMINGHAM VEIN CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30603 SOUTHFIELD ROAD
SOUTHFIELD MI
48076-7729
US

IV. Provider business mailing address

30603 SOUTHFIELD ROAD
SOUTHFIELD MI
48076-7729
US

V. Phone/Fax

Practice location:
  • Phone: 248-723-9370
  • Fax: 248-723-9687
Mailing address:
  • Phone: 248-723-9370
  • Fax: 248-723-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberRR047649
License Number StateMI

VIII. Authorized Official

Name: ROUCHDI M RIFAI
Title or Position: DOCTOR
Credential: MD
Phone: 248-723-9370