Provider Demographics
NPI:1821820952
Name:VERIFIED PROVIDER SERVICES PLLC
Entity type:Organization
Organization Name:VERIFIED PROVIDER SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JINIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:734-772-4722
Mailing Address - Street 1:25880 OUTER DR
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:844-509-4070
Mailing Address - Fax:800-509-3646
Practice Address - Street 1:25880 OUTER DR
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:844-509-4070
Practice Address - Fax:800-509-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty