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General NPI Number Information
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NPI Number | 1457302051
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Entity Type | Organization
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Legal Business Name | VEIN CENTER AT ALLURE MEDICAL SPA, PLLC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 8180 26 MILE RD SUITE 300
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-5129
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Country | US
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Telephone | 586-992-8300
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Fax | 586-992-9331
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Provider Business Mailing Address
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Address Line | 8180 26 MILE RD STE 300
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-5139
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Country | US
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Telephone | 586-992-8300
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Fax | 586-992-9331
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Authorized Official
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Title or Position | ADMINISTRATIVE
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Name | DEAN RYNKOWSKI
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Credential |
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Telephone | 586-992-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301096552
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101014643
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 5315053921
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101010912
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License Number State | MI
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