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General NPI Number Information
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NPI Number | 1215110614
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Entity Type | Organization
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Legal Business Name | VASSAR EXPRESS CLINIC PLC
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 193 W HURON
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City | VASSAR
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State | MI
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Zip | 48768
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Country | US
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Telephone | 989-823-3466
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Fax | 989-823-3666
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Provider Business Mailing Address
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Address Line | 3061 CHRISTY WAY
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City | SAGINAW
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State | MI
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Zip | 48603-2267
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Country | US
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Telephone | 989-791-2455
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Fax | 989-791-1392
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Authorized Official
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Title or Position | OWNER
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Name | NAVEED MAHFOOZ
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Credential | MD
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Telephone | 989-823-3466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BS083758
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | HK084207
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | NM059644
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | AM078432
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | WH089039
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License Number State | MI
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