Provider Demographics
NPI:1720167307
Name:ST CLAIR VASCULAR ASSOCIATES PC
Entity Type:Organization
Organization Name:ST CLAIR VASCULAR ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-772-4444
Mailing Address - Street 1:23829 LITTLE MACK
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST. CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1113
Mailing Address - Country:US
Mailing Address - Phone:586-772-4444
Mailing Address - Fax:586-772-4411
Practice Address - Street 1:23829 LITTLE MACK
Practice Address - Street 2:SUITE 200
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1113
Practice Address - Country:US
Practice Address - Phone:586-772-4444
Practice Address - Fax:586-772-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty