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General NPI Number Information
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NPI Number | 1093994337
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Entity Type | Organization
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Legal Business Name | NORTHERN MICHIGAN VASCULAR CENTER P.C.
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 3930 CEDAR RUN RD
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-9687
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Country | US
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Telephone | 231-935-0390
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Fax | 231-935-0395
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Provider Business Mailing Address
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Address Line | 3930 CEDAR RUN RD
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-9687
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Country | US
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Telephone | 231-935-0390
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Fax | 231-935-0395
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL DAVID COLBURN
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Credential | M.D.
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Telephone | 231-935-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 4301079215
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License Number State | MI
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