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General NPI Number Information
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NPI Number | 1710399001
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Entity Type | Organization
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Legal Business Name | JENNIFER VINCH MD PLLC
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 43200 DEQUINDRE RD STE 104
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City | STERLING HTS
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State | MI
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Zip | 48314-1707
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Country | US
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Telephone | 586-799-4350
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Fax | 586-799-4279
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Provider Business Mailing Address
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Address Line | 55495 PARKVIEW DR
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City | SHELBY TWP
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State | MI
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Zip | 48316-1031
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Country | US
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Telephone | 810-794-7750
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Fax | 810-794-7751
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER VINCH
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Credential | M.D.
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Telephone | 586-799-4350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301094469
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License Number State | MI
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