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General NPI Number Information
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NPI Number | 1508317728
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Entity Type | Organization
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Legal Business Name | EPMG TELEMED PLLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 2000 GREEN RD STE 300
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City | ANN ARBOR
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State | MI
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Zip | 48105-1575
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Country | US
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Telephone | 269-983-8300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80321
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City | PHILADELPHIA
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State | PA
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Zip | 19101-1321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KAREN VAUGHN
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Credential |
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Telephone | 404-450-4684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C090227
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License Number State | WI
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