Healthcare Provider Details

I. General information

NPI: 1164072765
Provider Name (Legal Business Name): VM PROVISION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 S CEDAR ST STE O
TACOMA WA
98409-5700
US

IV. Provider business mailing address

PO BOX 64375
TACOMA WA
98464-0375
US

V. Phone/Fax

Practice location:
  • Phone: 253-651-2498
  • Fax:
Mailing address:
  • Phone: 253-651-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ATIF MIAN
Title or Position: CEO
Credential: MD
Phone: 253-651-2498