Provider Demographics
NPI:1891967428
Name:LOPE A VITANGCOL JR MD PC
Entity Type:Organization
Organization Name:LOPE A VITANGCOL JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOPE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VITANGCOL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:269-473-3402
Mailing Address - Street 1:8740 N BLUFFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1490
Mailing Address - Country:US
Mailing Address - Phone:269-473-3402
Mailing Address - Fax:
Practice Address - Street 1:450 MEDICAL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-8549
Practice Address - Country:US
Practice Address - Phone:269-463-6490
Practice Address - Fax:269-463-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040457208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty