MEDICARE: VANTIS LLC

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	101YM0800X	Mental Health Counselor
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1710757760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANTIS LLC

Provider Business Mailing Address
First Line	:	320 E BIG BEAVER RD STE 185
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 E BIG BEAVER RD STE 185
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1238
Country	:	US
Telephone Number	:	248-294-0539
Fax Number	:	248-934-1390

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	PARAS PANCHOLI
Credential	:
Telephone Number	:	617-686-6251

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/02/2024

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Directions to “VANTIS LLC ” Practice Location

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