Provider Demographics
NPI:1821436171
Name:VLASIC, JEFFREY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:VLASIC
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 1:1500 E. MEDICAL CENTER DRIVE
Mailing Address - Street 2:B1-380 TC
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5305
Mailing Address - Country:US
Mailing Address - Phone:734-763-7919
Mailing Address - Fax:734-763-9298
Practice Address - Street 1:1500 E. MEDICAL CENTER DRIVE
Practice Address - Street 2:B1-380 TC
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5305
Practice Address - Country:US
Practice Address - Phone:734-763-7919
Practice Address - Fax:734-763-9298
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102827207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine