Provider Demographics
NPI:1073230876
Name:VITALITY VISITING PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:VITALITY VISITING PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPMO
Authorized Official - Phone:248-862-5311
Mailing Address - Street 1:18000 W 9 MILE RD STE 650
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4009
Mailing Address - Country:US
Mailing Address - Phone:248-862-5311
Mailing Address - Fax:248-243-1888
Practice Address - Street 1:18000 W 9 MILE RD STE 650
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4009
Practice Address - Country:US
Practice Address - Phone:248-862-5311
Practice Address - Fax:248-243-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty