Provider Demographics
NPI:1235144940
Name:VIGOR, DAVID NELSON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NELSON
Last Name:VIGOR
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 1:5938 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-9757
Mailing Address - Country:US
Mailing Address - Phone:517-339-6405
Mailing Address - Fax:517-339-6405
Practice Address - Street 1:350 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-1212
Practice Address - Country:US
Practice Address - Phone:616-897-8473
Practice Address - Fax:616-897-0081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010516462084P0800X, 2084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0330457OtherBLUE CROSS/BLUE SHIELD
MIP00092490OtherRAILROAD MEDICARE
MI4301051646OtherSTATE OF MICHIGAN LICENSE
MIE89362Medicare UPIN
MI0N09200Medicare ID - Type Unspecified
MI0N90200Medicare ID - Type UnspecifiedMEDICARE GROUP ID