Provider Demographics
NPI:1679500573
Name:SPURLIN, DAVID VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:VINCENT
Last Name:SPURLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:33301 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0905
Mailing Address - Country:US
Mailing Address - Phone:248-642-9111
Mailing Address - Fax:248-593-1713
Practice Address - Street 1:33301 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-0905
Practice Address - Country:US
Practice Address - Phone:248-642-9111
Practice Address - Fax:248-593-1713
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064183207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104038OtherGREAT LAKES HEALTH PLAN
MI1679500573OtherNPI
MI0706337892OtherBLUE CROSS BLUE SHIELD
C7166OtherMCARE
5363650OtherAETNA
MI0N23640Medicare Oscar/Certification
MIG14813Medicare UPIN