is a Vascular Surgery in Dearborn, Michigan. practices all healthcare services and medical treatments related to Vascular Surgery. The NPI Number for is 1922265982. The last update date is .
's current location address is 835 Mason St Ste D140, Dearborn, Michigan. You can contact this provider via phone number 3139144703 and fax number 3134380148. The mailing address for is 835 Mason St Ste D140, Dearborn, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 835 Mason St Ste D140, Dearborn, Michigan |
| Phone Number | 3139144703 |
| Fax Number | 3134380148 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1922265982 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 835 Mason St Ste D140 |
|---|---|
| City | Dearborn |
| State | Michigan (MI) |
| Post Code | 481242256 |
| Phone Number | 3139144703 |
| Fax Number | 3134380148 |
Provider's Primary Taxonomy Detail
| Speciality | Vascular Surgery |
|---|---|
| Taxonomy | 2086S0129X |
| Licence No | 4301034389 |
|
Definition: A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 101701996 | MI | -- | |
| 206353551 | MI | BCBS |
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