Provider Demographics
NPI:1902038466
Name:SIMI VANCISE M D PLLC
Entity Type:Organization
Organization Name:SIMI VANCISE M D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-463-5876
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0213
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:200 W CENTER ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-2207
Practice Address - Country:US
Practice Address - Phone:989-463-5876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty