Provider Demographics
NPI:1952633992
Name:SPECIALISTS VISITING PHYSICIANS PLLC
Entity Type:Organization
Organization Name:SPECIALISTS VISITING PHYSICIANS PLLC
Other - Org Name:HOPE SPECIALITS VISITING PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-597-0223
Mailing Address - Street 1:32500 CONCORD DR
Mailing Address - Street 2:SUITE 343
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1119
Mailing Address - Country:US
Mailing Address - Phone:248-597-0223
Mailing Address - Fax:248-498-6043
Practice Address - Street 1:32500 CONCORD DR
Practice Address - Street 2:SUITE 343
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1119
Practice Address - Country:US
Practice Address - Phone:248-597-0223
Practice Address - Fax:248-498-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty