Provider Demographics
NPI:1194202234
Name:MVP ENDOVASCULAR CENTER PLLC
Entity Type:Organization
Organization Name:MVP ENDOVASCULAR CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:REICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-697-8557
Mailing Address - Street 1:22720 MICHIGAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22720 MICHIGAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2035
Practice Address - Country:US
Practice Address - Phone:313-791-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-22
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty