MEDICARE: MVP ENDOVASCULAR CENTER PLLC

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1194202234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVP ENDOVASCULAR CENTER PLLC

Provider Business Mailing Address
First Line	:	22720 MICHIGAN AVE STE 300
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22720 MICHIGAN AVE STE 300
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2035
Country	:	US
Telephone Number	:	313-791-3000
Fax Number	:

Authorized Official
Title or Position	:	CONSULTING MANAGER
Name	:	JEFFREY ALLEN REICHMAN
Credential	:
Telephone Number	:	513-697-8557

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	07/20/2022

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