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General NPI Number Information
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NPI Number | 1609077783
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Entity Type | Organization
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Legal Business Name | MICHIGAN VASCULAR ACCESS, PC
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 21701 W 11 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3713
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Country | US
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Telephone | 248-355-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 21701 W 11 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3713
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Country | US
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Telephone | 248-355-1100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARC WEBB
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Credential | M D
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Telephone | 248-355-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MW051199
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License Number State | MI
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