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General NPI Number Information
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NPI Number | 1841461548
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Entity Type | Organization
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Legal Business Name | THE VEIN CLINIC AT UNASOURCE, P.L.C.
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 4550 INVESTMENT DRIVE SUITE 270
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City | TROY
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State | MI
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Zip | 48098-6362
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Country | US
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Telephone | 248-267-5015
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Fax | 248-267-5016
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Provider Business Mailing Address
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Address Line | 4550 INVESTMENT DRIVE SUITE 270
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City | TROY
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State | MI
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Zip | 48098-6362
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Country | US
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Telephone | 248-267-5015
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Fax | 248-267-5016
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY A BIEREMA
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Credential | M.D.
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Telephone | 248-267-5015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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