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General NPI Number Information
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NPI Number | 1972251437
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Entity Type | Organization
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Legal Business Name | VMD PRIMARY PROVIDERS EASTERN MICHIGAN, PC
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 27275 HAGGERTY RD STE 500
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City | NOVI
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State | MI
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Zip | 48377-3635
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Country | US
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Telephone | 734-224-8317
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Fax |
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Provider Business Mailing Address
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Address Line | 125 S CLARK ST STE 900
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City | CHICAGO
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State | IL
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Zip | 60603-4043
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Country | US
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Telephone | 888-978-1055
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Fax | 713-981-6312
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Authorized Official
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Title or Position | DIRECTOR REVENUE CYCLE
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Name | REBECCA RAGER
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Credential |
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Telephone | 844-969-0686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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