MEDICARE: ANTONIO VASQUEZ, MD 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
1	2086S0129X	Vascular Surgery Physician	AV034932	MI

General Provider Information

NPI Number	:	1700060464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTONIO VASQUEZ, MD PC

Provider Business Mailing Address
First Line	:	2010 15TH ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7606
Country	:	US
Telephone Number	:	989-893-8361
Fax Number	:	989-893-3528

Provider Business Practice Location Address
First Line	:	2010 15TH ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7606
Country	:	US
Telephone Number	:	989-893-8361
Fax Number	:	989-893-3528

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NOREEN HATTON
Credential	:
Telephone Number	:	989-893-8361

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	12/18/2007

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