Provider Demographics
NPI:1790965838
Name:JOHN A. VOLLMER, MD, PC
Entity Type:Organization
Organization Name:JOHN A. VOLLMER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VOLLMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-777-4668
Mailing Address - Street 1:25250 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4473
Mailing Address - Country:US
Mailing Address - Phone:586-777-4668
Mailing Address - Fax:586-777-4452
Practice Address - Street 1:25250 KELLY RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4473
Practice Address - Country:US
Practice Address - Phone:586-777-4668
Practice Address - Fax:586-777-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJV046289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0805016351OtherBLUE CROSS BLUE SHIELD
MIJV046289OtherSTATE LICENSE
MIJV046289OtherSTATE LICENSE
AV2335710OtherDEA NUMBER
MI0805016351OtherBLUE CROSS BLUE SHIELD