Provider Demographics
NPI:1518011360
Name:TOTAL VEIN CARE CLINIC, P.C.
Entity Type:Organization
Organization Name:TOTAL VEIN CARE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-999-3930
Mailing Address - Street 1:3515 COOLIDGE RD
Mailing Address - Street 2:STE B
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-999-3930
Mailing Address - Fax:517-999-3931
Practice Address - Street 1:3515 COOLIDGE RD
Practice Address - Street 2:STE B
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-999-3930
Practice Address - Fax:517-999-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGL0094522086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty