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General NPI Number Information
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NPI Number | 1760884449
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Entity Type | Organization
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Legal Business Name | VIBHA
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 1375 FLUSHING RD
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City | FLUSHING
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State | MI
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Zip | 48433-2262
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Country | US
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Telephone | 810-659-2233
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Fax | 810-659-2246
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Provider Business Mailing Address
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Address Line | 1375 FLUSHING RD
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City | FLUSHING
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State | MI
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Zip | 48433-2262
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Country | US
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Telephone | 810-659-2233
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Fax | 810-659-2246
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARILYN ACHEFF
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Credential |
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Telephone | 810-659-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301081972
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License Number State | MI
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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 | 4301081972
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License Number State | MI
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