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General NPI Number Information
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NPI Number | 1609683911
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Entity Type | Organization
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Legal Business Name | MICHIGAN VASECTOMY
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 710 AVIS DR STE 200
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City | ANN ARBOR
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State | MI
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Zip | 48108-9517
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Country | US
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Telephone | 248-834-3512
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Fax |
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Provider Business Mailing Address
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Address Line | 359 ENTERPRISE CT STE C
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City | BLOOMFIELD TOWNSHIP
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State | MI
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Zip | 48302-1055
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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 | AUTHORIZED OFFICIAL
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Name | BILJANA TRUJILLO
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Credential |
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Telephone | 248-834-3512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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