Provider Demographics
NPI:1629209374
Name:VASCULAR AND ENDOVASCULAR INSTITUTE OF MICHIGAN PC
Entity Type:Organization
Organization Name:VASCULAR AND ENDOVASCULAR INSTITUTE OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIZK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-228-3180
Mailing Address - Street 1:15945 19 MILE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1147
Mailing Address - Country:US
Mailing Address - Phone:586-228-3180
Mailing Address - Fax:586-228-6613
Practice Address - Street 1:15945 19 MILE RD
Practice Address - Street 2:STE 104
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1147
Practice Address - Country:US
Practice Address - Phone:586-228-3180
Practice Address - Fax:586-228-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty