Provider Demographics
NPI:1457302051
Name:VEIN CENTER AT ALLURE MEDICAL SPA, PLLC
Entity Type:Organization
Organization Name:VEIN CENTER AT ALLURE MEDICAL SPA, PLLC
Other - Org Name:CHARLES MOK, DO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-992-8300
Mailing Address - Street 1:8180 26 MILE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5139
Mailing Address - Country:US
Mailing Address - Phone:586-992-8300
Mailing Address - Fax:586-992-9331
Practice Address - Street 1:8180 26 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5129
Practice Address - Country:US
Practice Address - Phone:586-992-8300
Practice Address - Fax:586-992-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096552207N00000X
MI5101014643207R00000X
MI5101010912208600000X
MI53150539212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457302051Medicaid
MI201981170OtherALL INSURANCE
MI201981170OtherALL INSURANCE