Provider Demographics
NPI:1841205473
Name:WILLIAM J VASILEFF MD PC
Entity Type:Organization
Organization Name:WILLIAM J VASILEFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:248-644-0670
Mailing Address - Street 1:525 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1620
Mailing Address - Country:US
Mailing Address - Phone:248-644-0670
Mailing Address - Fax:248-644-2619
Practice Address - Street 1:525 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1620
Practice Address - Country:US
Practice Address - Phone:248-644-0670
Practice Address - Fax:248-644-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWV044693208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM11530001Medicare ID - Type Unspecified
B43301Medicare UPIN