=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457889370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALVIN JOHN RAMOS VARGAS DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2017
-----------------------------------------------------
Last Update Date | 04/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19000 ST JOES PKWY STE 330
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48152-1477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-884-5263
-----------------------------------------------------
Fax | 734-884-5264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 FRANK LLOYD WRIGHT DR # J2000
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-9484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-747-6766
-----------------------------------------------------
Fax | 734-222-3100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 5101025639
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5101025639
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------