Provider Demographics
NPI:1194864462
Name:VANGUARD FAMILY HEALTH CARE PC
Entity Type:Organization
Organization Name:VANGUARD FAMILY HEALTH CARE PC
Other - Org Name:VANGUARD FAMILY HEALT H CARE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-824-1000
Mailing Address - Street 1:10809 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2119
Mailing Address - Country:US
Mailing Address - Phone:313-824-1000
Mailing Address - Fax:313-824-9000
Practice Address - Street 1:10809 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2119
Practice Address - Country:US
Practice Address - Phone:313-824-1000
Practice Address - Fax:313-824-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMP005908207Q00000X
MIJB002247213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty