1174597991 NPI number — CAREY M VIGOR MD PC

Table of content: (NPI 1174597991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174597991 NPI number — CAREY M VIGOR MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREY M VIGOR MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174597991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18530 MACK AVE
Provider Second Line Business Mailing Address:
# 478
Provider Business Mailing Address City Name:
GROSSE POINTE FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-3254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-615-4323
Provider Business Mailing Address Fax Number:
810-794-1844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2725 PACKARD RD
Provider Second Line Business Practice Location Address:
# 101
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48108-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-615-4323
Provider Business Practice Location Address Fax Number:
810-794-1844
Provider Enumeration Date:
02/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIGOR
Authorized Official First Name:
CAREY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRES CEO
Authorized Official Telephone Number:
586-615-4323

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  4301039392 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0600X , with the licence number: 4301039392 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: 4301039392 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)