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General NPI Number Information
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NPI Number | 1184898454
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Entity Type | Organization
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Legal Business Name | PETER S VASIU DO PC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 2591 44TH ST SE SUITE 103
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City | KENTWOOD
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State | MI
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Zip | 49512-9094
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Country | US
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Telephone | 616-281-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 2591 44TH ST SE SUITE 103
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City | KENTWOOD
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State | MI
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Zip | 49512-9094
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Country | US
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Telephone | 616-281-7000
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. AMY J DEGOOD
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Credential |
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Telephone | 616-281-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101012366
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License Number State | MI
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