Provider Demographics
NPI:1477976686
Name:VITAL COMMUNITY CARE P C
Entity Type:Organization
Organization Name:VITAL COMMUNITY CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUKKOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-851-0500
Mailing Address - Street 1:24371 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2929
Mailing Address - Country:US
Mailing Address - Phone:248-809-6088
Mailing Address - Fax:248-809-6085
Practice Address - Street 1:24371 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2929
Practice Address - Country:US
Practice Address - Phone:248-809-6088
Practice Address - Fax:248-809-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care