Provider Demographics
NPI:1538136072
Name:COMPREHENSIVE VASCULAR CARE, P.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE VASCULAR CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LLEWELLYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-424-5748
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 555
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-424-5748
Mailing Address - Fax:248-443-1706
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 555
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-424-5748
Practice Address - Fax:248-443-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID #