Provider Demographics
NPI:1043221435
Name:VHS PHYSICIANS OF MICHIGAN
Entity Type:Organization
Organization Name:VHS PHYSICIANS OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:W
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-832-6034
Mailing Address - Street 1:4160 JOHN R ST STE 404S
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2021
Mailing Address - Country:US
Mailing Address - Phone:248-450-3507
Mailing Address - Fax:248-796-0177
Practice Address - Street 1:4160 JOHN R
Practice Address - Street 2:STE 708
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-832-6034
Practice Address - Fax:313-832-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038283207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0826215OtherBCBS
0826215Medicare ID - Type Unspecified
MI0826215OtherBCBS
A77353Medicare UPIN