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General NPI Number Information
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NPI Number | 1801636121
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Entity Type | Organization
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Legal Business Name | VDM OF MICHIGAN
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 43211 DALCOMA DR STE 6
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6309
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Country | US
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Telephone | 979-900-7151
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Fax | 800-878-3830
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Provider Business Mailing Address
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Address Line | 11200 BROADWAY ST STE 2743
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City | PEARLAND
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State | TX
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Zip | 77584-9787
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Country | US
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Telephone | 800-409-1920
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED MEMBER
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Name | DR. MARILOU ORO
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Credential | DNP
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Telephone | 346-471-8251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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