MEDICARE: MICHAEL JOHN VILAG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901021030	MI

General Provider Information

NPI Number	:	1174965339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOHN VILAG D.D.S.

Provider Business Mailing Address
First Line	:	24201 MERIDIAN RD
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-2134
Country	:	US
Telephone Number	:	734-692-0102
Fax Number	:	734-692-1541

Provider Business Practice Location Address
First Line	:	24201 MERIDIAN RD
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-2134
Country	:	US
Telephone Number	:	734-692-0102
Fax Number	:	734-692-1541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	01/11/2020

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