Provider Demographics
NPI:1013365097
Name:VIRTUE LUNG INSTITUTE PC
Entity Type:Organization
Organization Name:VIRTUE LUNG INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KEFRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-462-5858
Mailing Address - Street 1:14555 LEVAN RD
Mailing Address - Street 2:STE 309
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5083
Mailing Address - Country:US
Mailing Address - Phone:734-462-5858
Mailing Address - Fax:734-462-5860
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:STE 309
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-462-5858
Practice Address - Fax:734-462-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055827207RP1001X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty