Provider Demographics
NPI:1558149690
Name:ENDOVASCULAR PHYSICIANS OF MICHIGAN PC
Entity Type:Organization
Organization Name:ENDOVASCULAR PHYSICIANS OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQQANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-302-4800
Mailing Address - Street 1:5213 W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-8214
Mailing Address - Country:US
Mailing Address - Phone:989-302-4800
Mailing Address - Fax:
Practice Address - Street 1:5213 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8214
Practice Address - Country:US
Practice Address - Phone:989-302-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty