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NPI Code Detail

MEDICARE: VANGUARD FAMILY HEALTH CARE PC

MEDICARE: VANGUARD FAMILY HEALTH CARE PC
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
1213E00000XPodiatristJB002247MI
2207Q00000XFamily Medicine PhysicianMP005908MI

General Provider Information

NPI Number : 1194864462
Entity Type Code : Organization
Provider Name (Legal Business Name) : VANGUARD FAMILY HEALTH CARE PC
Provider Business Mailing Address
First Line : 10809 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-2119
Country : US
Telephone Number : 313-824-1000
Fax Number : 313-824-9000
Provider Business Practice Location Address
First Line : 10809 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-2119
Country : US
Telephone Number : 313-824-1000
Fax Number : 313-824-9000
Authorized Official
Title or Position : SECRETARY
Name : MS. LINDA POPOFF
Credential :
Telephone Number : 313-824-1000
Provider Enumeration Date : 02/05/2007
Last Update Date : 08/07/2015

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Directions to “VANGUARD FAMILY HEALTH CARE PC ” Practice Location

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