Provider Demographics
NPI:1740358209
Name:VEIN CENTER AND MEDICAL SPA
Entity type:Organization
Organization Name:VEIN CENTER AND MEDICAL SPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AMALFITANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-941-7500
Mailing Address - Street 1:4020 COPPER VW
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7098
Mailing Address - Country:US
Mailing Address - Phone:231-941-7500
Mailing Address - Fax:231-940-7509
Practice Address - Street 1:4020 COPPER VW STE 212
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7041
Practice Address - Country:US
Practice Address - Phone:231-941-7500
Practice Address - Fax:231-941-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5281088OtherBLUE CROSS BLUE SHIELD