Healthcare Provider Details

I. General information

NPI: 1447878160
Provider Name (Legal Business Name): USA VEIN CLINICS OF DETROIT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29984 TELEGRAPH RD
SOUTHFIELD MI
48034-1355
US

IV. Provider business mailing address

304 WAINWRIGHT DR
NORTHBROOK IL
60062-1900
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-8460
  • Fax:
Mailing address:
  • Phone: 847-593-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMI ALMEDA
Title or Position: SR. CREDENTIALING MANAGER
Credential:
Phone: 847-593-8460