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General NPI Number Information
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NPI Number | 1871922757
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Entity Type | Organization
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Legal Business Name | VISION OF HEALTH & FUNCTIONAL MEDICINE
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 740 7TH ST
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City | BALDWIN
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State | MI
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Zip | 49304-7895
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Country | US
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Telephone | 231-745-9520
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Fax | 231-745-9252
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Provider Business Mailing Address
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Address Line | 740 7TH ST
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City | BALDWIN
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State | MI
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Zip | 49304-7895
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Country | US
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Telephone | 231-745-9520
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Fax | 231-745-9252
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VERNON E. PROCTOR
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Credential | M.D.
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Telephone | 231-745-9250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301089365
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License Number State | MI
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