Provider Demographics
NPI:1093926214
Name:TRENT, VINCENT SHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:SHAWN
Last Name:TRENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LAKE VILLAGE BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1679
Mailing Address - Country:US
Mailing Address - Phone:313-410-4061
Mailing Address - Fax:
Practice Address - Street 1:113 LAKE VILLAGE BLVD APT 101
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1679
Practice Address - Country:US
Practice Address - Phone:313-410-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060421207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology