Provider Demographics
NPI:1336306018
Name:DEBRA M VANORT DO PC
Entity Type:Organization
Organization Name:DEBRA M VANORT DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-676-8110
Mailing Address - Street 1:1501 N MILFORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1006
Mailing Address - Country:US
Mailing Address - Phone:248-676-8110
Mailing Address - Fax:248-676-8118
Practice Address - Street 1:1501 N MILFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1006
Practice Address - Country:US
Practice Address - Phone:248-676-8110
Practice Address - Fax:248-676-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDV009592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M18660Medicare PIN