Provider Demographics
NPI:1114103314
Name:VAGOTIS, FRANCINE LEA (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCINE
Middle Name:LEA
Last Name:VAGOTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANCINE
Other - Middle Name:LEA
Other - Last Name:VAGOTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:770 KENMOOR AVE SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8621
Mailing Address - Country:US
Mailing Address - Phone:616-285-6400
Mailing Address - Fax:616-285-0417
Practice Address - Street 1:770 KENMOOR AVE SE
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8621
Practice Address - Country:US
Practice Address - Phone:616-285-6400
Practice Address - Fax:616-285-0417
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist