Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 5601009794 | MI |
NPI | 1215569033 |
---|---|
Provider Name | Morgan Vitale |
First Address | Warren, MI 48093-5400 |
Second Address | Warren, MI 48093-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2020 |
Last Update Date | 30/04/2020 |