Provider Demographics
NPI:1760900138
Name:INTEGRATED VASCULAR VEIN CENTER OF MICHIGAN PC
Entity Type:Organization
Organization Name:INTEGRATED VASCULAR VEIN CENTER OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-955-4671
Mailing Address - Street 1:600 HEALTH PARK BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2558
Mailing Address - Country:US
Mailing Address - Phone:810-606-1660
Mailing Address - Fax:
Practice Address - Street 1:600 HEALTH PARK BLVD STE G
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2558
Practice Address - Country:US
Practice Address - Phone:810-606-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty