Provider Demographics
NPI:1477710135
Name:ELCTRODIAGNOSTIC MEDICINE CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:ELCTRODIAGNOSTIC MEDICINE CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:517-374-1055
Mailing Address - Street 1:1515 LAKE LANSING RD
Mailing Address - Street 2:SUITE F-1
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3753
Mailing Address - Country:US
Mailing Address - Phone:517-374-1055
Mailing Address - Fax:517-374-1061
Practice Address - Street 1:1515 LAKE LANSING RD
Practice Address - Street 2:SUITE F-1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3753
Practice Address - Country:US
Practice Address - Phone:517-374-1055
Practice Address - Fax:517-374-1061
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
MI43010351332084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1687260Medicaid
MI0331291OtherMEDICARE ID-TYPE UNSPECIFIED
MI0331291OtherMEDICARE ID-TYPE UNSPECIFIED