Provider Demographics
NPI:1508417197
Name:VPS OF MI PLLC
Entity Type:Organization
Organization Name:VPS OF MI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAYAL
Authorized Official - Middle Name:JINIT
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:248-509-4070
Mailing Address - Street 1:25880 OUTER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1553
Mailing Address - Country:US
Mailing Address - Phone:248-509-4070
Mailing Address - Fax:248-509-4080
Practice Address - Street 1:25880 OUTER DR STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1553
Practice Address - Country:US
Practice Address - Phone:248-509-4070
Practice Address - Fax:248-509-4080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VPS OF MI PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1164873691Medicaid