MICHIGAN VASCULAR INSTITUTE PLLC (NPI# 1093915910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093915910 |
| Entity Type | Organization |
| Organization Name | MICHIGAN VASCULAR INSTITUTE PLLC |
| Practice Address |
1030 Harrington St Suite 103 Mount Clemens MI 48043-2967 |
| Practice Telephone | 5864933175 |
| Practice Fax Number | 5864933828 |
| Mailing Telephone | 5864933175 |
| Mailing Fax Number | 5864933828 |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2007-07-19 |
| Authorized Official Name | DR. GREGORY P. DERDERIAN (PRESIDENT) |
| Authorized Official Telephone | 5864933175 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
5101007182 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
1030 HARRINGTON ST SUITE 103 |
| City | MOUNT CLEMENS |
| State | MI |
| Zip Code | 48043-2967 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295725620 | Stephen Douglas Cahill | Surgery | 1030 Harrington St, Suite 103, Mount Clemens, MI 48043-2967 | 2005-10-26 |
| 1053703074 | Carmen Epstein | Dietitian, Registered | 1030 Harrington St, Suite 202, Mount Clemens, MI 48043-2967 | 2015-02-27 |
| 1447692819 | Kim N Poludnianyk Do PC | Orthopaedic Surgery | 1030 Harrington St, Suite 303, Mount Clemens, MI 48043-2967 | 2013-07-25 |
| 1144531500 | Ashley N Harnden | Surgery | 1030 Harrington St, Suite 103, Mount Clemens, MI 48043-2967 | 2010-06-30 |
| 1457591174 | Select Surgical Pllc | Surgery | 1030 Harrington St, 103, Mount Clemens, MI 48043-2967 | 2009-02-21 |
| 1750544268 | Sibin K Zacharias | Internal Medicine | 1030 Harrington St, Ste 101, Mount Clemens, MI 48043-2967 | 2008-07-03 |
| 1174704985 | Carol M Fischer Do Pllc | Clinic/Center | 1030 Harrington St, Suite 201, Mount Clemens, MI 48043-2967 | 2007-11-20 |
| 1689879629 | Michigan Neurology, P.l.l.c. | Specialist | 1030 Harrington St, Suite 205, Mount Clemens, MI 48043-2967 | 2007-06-19 |
| 1962550053 | Michigan Oncology Hematology Pllc | Specialist | 1030 Harrington St, Suite 103, Mount Clemens, MI 48043-2967 | 2007-01-08 |
| 1114074218 | University Neurosurgical Associates, PC | Neurological Surgery | 1030 Harrington St, Suite 205, Mount Clemens, MI 48043-2967 | 2007-01-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699300228 | Blue Diamond Aba Services LLC | Assistant Behavior Analyst | 102 North Avenue, Mt. Clemens, MI 48043 | 2020-03-04 |
| 1265086136 | Venture Counseling | Social Worker | 198 S. Main Street, Suite 2, Mount Clemens, MI 48043 | 2019-07-30 |
| 1386203651 | Michele Lee Casebolt | Physical Therapist | 30795 Twenty Three Mile Rd., Chesterfield, MI 48043 | 2019-06-11 |
| 1730669706 | Wynn A Mitchell | Case Manager/Care Coordinator | 24 Hubbard St, Mount Clemens, MI 48043 | 2018-08-18 |
| 1629520101 | Boitshoko Marang | Family Medicine | Clinton River Drive 11a, Mount Clemens, MI 48043 | 2016-10-31 |
| 1720332265 | New Passages | Point of Service | 175 N. Grorsebeck Hwy, Mt. Clemens, MI 48043 | 2012-11-06 |
| 1376807784 | Christopher John Shamass | Emergency Medicine | 1000 Harrington Boulevard, Mount Clemens, MI 48043 | 2012-06-29 |
| 1265749683 | Mycare Health Center | Clinic/Center | 18 Market Street, Suite C, Mount Clemens, MI 48043 | 2010-09-07 |
| 1114102837 | George Edward Perron | Family Medicine | 256 Wellington Crescent, Mt Clemens, MI 48043 | 2007-12-31 |
| 1558568733 | Dawood Ghassan Dalaly | Surgery | 1000 Harrington, Mt Clemens, MI 48043 | 2007-06-29 |
| Find all providers in zip 48043 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437660057 | Iha Health Services Corporation | Surgery | 5333 Mcauley Dr Rm 4016, Ypsilanti, MI 48197-1001 | 2017-10-23 |
| 1760900138 | Integrated Vascular Vein Center of Michigan PC | Surgery | 600 Health Park Blvd Ste G, Grand Blanc, MI 48439-2558 | 2017-09-06 |
| 1770036147 | Joseph P. Elliott Jr. | Surgery | 3282 Woodview Lake Rd, West Bloomfield, MI 48323-3570 | 2016-08-02 |
| 1043676661 | Integrative Cardiovascular Health & Wellness | Surgery | 3250 Woods Way, Suite 9, Petoskey, MI 49770-7628 | 2016-01-12 |
| 1124411244 | Vascular Surgery Assoc, PC | Surgery | 1122 S Lapeer Rd Ste C, Lapeer, MI 48446-3387 | 2015-03-13 |
| 1013309988 | Bloomfield Vein & Vascular Pllc | Surgery | 43700 Woodward Ave Ste 207, Bloomfield Hills, MI 48302-5061 | 2015-03-02 |
| 1114288206 | Scott Bendix | Surgery | 28100 Grand River Ave Ste 200, Farmington Hills, MI 48336-5969 | 2012-06-05 |
| 1942561428 | Charles J Shanley Md PC | Surgery | 1001 Audubon Rd, Grosse Pointe, MI 48230-1406 | 2012-05-31 |
| 1508122995 | Robert J Cardwell Md Pllc | Surgery | 13312 Terry Dr, Shelby Township, MI 48315-5365 | 2012-04-10 |
| 1780919936 | Martin A V Tuma Md Vascular Surgery Pllc | Surgery | 22255 Greemfield Road #250, Southfield, MI 48075 | 2009-10-06 |
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| City | MOUNT CLEMENS |
| Zip Code | 48043 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.