Provider Demographics
NPI:1962480228
Name:VITANGCOL, LOPE ALVARAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LOPE
Middle Name:ALVARAN
Last Name:VITANGCOL
Suffix:JR
Gender:M
Credentials:MD
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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:269-463-6454
Practice Address - Street 1:450 MEDICAL PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-8531
Practice Address - Country:US
Practice Address - Phone:269-463-6490
Practice Address - Fax:269-463-6454
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2011-09-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301040457208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101418979Medicaid
MI101418979Medicaid
0114971Medicare ID - Type Unspecified
MI101418979Medicaid