Provider Demographics
NPI:1063639383
Name:VEIN INSTITUTE OF SOUTHWEST MICHIGAN, PLLC
Entity Type:Organization
Organization Name:VEIN INSTITUTE OF SOUTHWEST MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-963-9556
Mailing Address - Street 1:126 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3461
Mailing Address - Country:US
Mailing Address - Phone:269-963-9556
Mailing Address - Fax:269-963-1522
Practice Address - Street 1:126 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3461
Practice Address - Country:US
Practice Address - Phone:269-963-9556
Practice Address - Fax:269-963-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty