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NPI Code Detail

MEDICARE: VITAE HEALTH MEDICAL MICHIGAN PLLC

MEDICARE: VITAE HEALTH MEDICAL MICHIGAN 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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1629695283
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITAE HEALTH MEDICAL MICHIGAN PLLC
Provider Business Mailing Address
First Line : 3450 OAKTON ST STE 300
Second Line :
City : SKOKIE
State : IL
Zip : 60076-2951
Country : US
Telephone Number : 224-777-8034
Fax Number :
Provider Business Practice Location Address
First Line : 26505 POWERS AVE
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-1327
Country : US
Telephone Number : 224-777-8034
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : YITZCHAK FREUND
Credential :
Telephone Number : 224-777-8045
Provider Enumeration Date : 06/30/2020
Last Update Date : 03/25/2025

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