Provider Demographics
NPI:1558741819
Name:VICINITAS MICHIGAN, INC.
Entity Type:Organization
Organization Name:VICINITAS MICHIGAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PREATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-430-4162
Mailing Address - Street 1:5900 BROKEN SOUND PKWY NW
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2797
Mailing Address - Country:US
Mailing Address - Phone:561-430-4162
Mailing Address - Fax:
Practice Address - Street 1:30600 TELEGRAPH RD
Practice Address - Street 2:SUITE 2345
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4530
Practice Address - Country:US
Practice Address - Phone:561-430-4162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology