Provider Demographics
NPI:1205688173
Name:VERGOS, NICHOLAS PETER
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PETER
Last Name:VERGOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1457
Mailing Address - Country:US
Mailing Address - Phone:810-244-3434
Mailing Address - Fax:
Practice Address - Street 1:3385 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1457
Practice Address - Country:US
Practice Address - Phone:810-244-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty