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General NPI Number Information
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NPI Number | 1831752674
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Entity Type | Organization
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Legal Business Name | EPMG SOUTHWEST MICHIGAN PLLC
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 31 N SAINT JOSEPH AVE
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City | NILES
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State | MI
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Zip | 49120-2207
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Country | US
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Telephone | 269-683-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 NW 62ND ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-1831
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Country | US
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Telephone | 973-251-1132
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KAREN VAUGHN
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Credential |
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Telephone | 404-450-4684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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