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General NPI Number Information
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NPI Number | 1639837487
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Entity Type | Organization
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Legal Business Name | VKTR VISITING PHYSICIAN GROUP PLLC
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 4777 E OUTER DR
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City | DETROIT
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State | MI
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Zip | 48234-3241
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Country | US
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Telephone | 248-914-1681
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Fax |
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Provider Business Mailing Address
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Address Line | 17663 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2756
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Country | US
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Telephone | 248-914-1681
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Fax | 248-557-7883
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | BENJAMIN HOLLAWAY
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Credential |
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Telephone | 248-914-1681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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