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General NPI Number Information
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NPI Number | 1073230876
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Entity Type | Organization
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Legal Business Name | VITALITY VISITING PHYSICIANS, PLLC
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 16250 NORTHLAND DR STE 318
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5228
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Country | US
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Telephone | 248-862-5311
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Fax | 248-671-0175
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Provider Business Mailing Address
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Address Line | 18000 W 9 MILE RD STE 650
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4009
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Country | US
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Telephone | 248-862-5311
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Fax | 248-243-1888
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Authorized Official
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Title or Position | OWNER
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Name | VARSHA BALDRIDGE
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Credential |
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Telephone | 248-862-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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