Healthcare Provider Details
I. General information
NPI: 1962198192
Provider Name (Legal Business Name): VAC HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5449 S OCCIDENTAL RD
TECUMSEH MI
49286-9782
US
IV. Provider business mailing address
5449 S OCCIDENTAL RD
TECUMSEH MI
49286-9782
US
V. Phone/Fax
- Phone: 517-423-3901
- Fax: 517-423-8199
- Phone: 517-423-3901
- Fax: 517-423-8199
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2083X0100X |
| Taxonomy | Occupational Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MRS.
ALLIE
LEE
CHERFAN
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: DO
Phone: 734-634-6343