Provider Demographics
NPI:1043806730
Name:VITALITY MED PLLC
Entity Type:Organization
Organization Name:VITALITY MED PLLC
Other - Org Name:VITALITY MED LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-673-6144
Mailing Address - Street 1:1800 W CARO RD STE VI
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-8209
Mailing Address - Country:US
Mailing Address - Phone:989-673-6144
Mailing Address - Fax:989-672-1800
Practice Address - Street 1:1800 W CARO RD STE VI
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-8209
Practice Address - Country:US
Practice Address - Phone:989-673-6144
Practice Address - Fax:989-672-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty