| Normita Vicencio Md Pc | |
|
4020 Venoy Rd Ste 300 Wayne MI 48184-1899 | |
| (734) 728-2909 | |
| Not Available |
| Full Name | Normita Vicencio Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4020 Venoy Rd Ste 300, Wayne, Michigan |
| Authorized Official Name and Position | Normita Vicencio (OWNER) |
| Authorized Official Contact | 7347282909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Normita Vicencio Md Pc 4020 Venoy Rd Ste 300 Wayne MI 48184-1899 Ph: (734) 728-2909 | Normita Vicencio Md Pc 4020 Venoy Rd Ste 300 Wayne MI 48184-1899 Ph: (734) 728-2909 |
| NPI Number | 1841493616 |
|---|---|
| Provider Enumeration Date | 06/07/2007 |
| Last Update Date | 10/08/2014 |
| Medicare PECOS PAC ID | 7113019803 |
|---|---|
| Medicare Enrollment ID | O20070827000246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841493616 | NPI | - | NPPES |
| 101703758 | Medicaid | MI | |
| 108010 | Other | MI | CARE CHOICES |
| 110154734 | Other | MI | MEDICARE RAILROAD |
| 1108258662 | Other | MI | BCBSM |
| C5295 | Other | MI | MCARE |
| 1108258662 | Other | MI | BLUE CARE NETWORK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | NV032288 (Michigan) | Primary |
| Provider Name | Normita D Vicencio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700973385 PECOS PAC ID: 4486754603 Enrollment ID: I20070717000228 |
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