Provider Demographics
NPI:1073827101
Name:VHS PHYSICIANS OF MICHIGAN
Entity Type:Organization
Organization Name:VHS PHYSICIANS OF MICHIGAN
Other - Org Name:DMC MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CFO TPR TENET
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2532
Mailing Address - Street 1:PO BOX 18998
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:248-455-0864
Mailing Address - Fax:708-342-6655
Practice Address - Street 1:29201 TELEGRAPH RD STE 404N
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7647
Practice Address - Country:US
Practice Address - Phone:248-450-3507
Practice Address - Fax:248-796-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1073827101Medicaid
MIMI3973Medicare PIN