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General NPI Number Information
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NPI Number | 1457496952
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Entity Type | Organization
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Legal Business Name | VICENTE D CABANSAG JR MD PC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 68930 VINEWOOD AVE
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City | STURGIS
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State | MI
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Zip | 49091-8899
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Country | US
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Telephone | 269-651-9302
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Fax | 269-651-4809
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Provider Business Mailing Address
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Address Line | 68930 VINEWOOD AVE
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City | STURGIS
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State | MI
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Zip | 49091-8899
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Country | US
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Telephone | 269-651-9302
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Fax | 269-651-4809
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICENTE D CABANSAG JR.
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Credential | M.D.
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Telephone | 269-651-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 033706
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 033706
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301080148
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License Number State | MI
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