Provider Demographics
NPI:1598053142
Name:VINTON, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:VINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 3RD ST
Mailing Address - Street 2:200
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2605
Mailing Address - Country:US
Mailing Address - Phone:734-697-9065
Mailing Address - Fax:734-697-9049
Practice Address - Street 1:201 3RD ST
Practice Address - Street 2:200
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2605
Practice Address - Country:US
Practice Address - Phone:734-697-9065
Practice Address - Fax:734-697-9049
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine