Provider Demographics
NPI:1831125301
Name:VAS, VERONICA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:L
Last Name:VAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 M 139
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3881
Mailing Address - Country:US
Mailing Address - Phone:269-927-5400
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:50 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1246
Practice Address - Country:US
Practice Address - Phone:269-427-7937
Practice Address - Fax:269-427-5180
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4793515 -Medicaid
MI1601110802OtherBLUE CROSS PIN
MIBV5452862OtherDEA
H28897Medicare UPIN
MIBV5452862OtherDEA