Provider Demographics
NPI:1891109641
Name:INTEGRATED VISITING PHYSICIAN SOLUTIONS PC
Entity Type:Organization
Organization Name:INTEGRATED VISITING PHYSICIAN SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-327-6196
Mailing Address - Street 1:21650 W 11 MILE RD
Mailing Address - Street 2:202
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3777
Mailing Address - Country:US
Mailing Address - Phone:248-327-6196
Mailing Address - Fax:248-327-6356
Practice Address - Street 1:21650 W 11 MILE RD
Practice Address - Street 2:202
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3777
Practice Address - Country:US
Practice Address - Phone:248-327-6196
Practice Address - Fax:248-327-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI05804G251E00000X
251E00000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251E00000XAgenciesHome Health