| Vitality Med Llc | |
|
1800 W Caro Rd Ste Vi Caro MI 48723-8209 | |
| (989) 673-6144 | |
| (989) 672-1800 |
| Full Name | Vitality Med Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1800 W Caro Rd Ste Vi, Caro, Michigan |
| Authorized Official Name and Position | Megan Putman (ADMINISTRATOR) |
| Authorized Official Contact | 9896736144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Med Llc 1800 W Caro Rd Ste Vi Caro MI 48723-8209 Ph: (989) 673-6144 | Vitality Med Llc 1800 W Caro Rd Ste Vi Caro MI 48723-8209 Ph: (989) 673-6144 |
| NPI Number | 1043806730 |
|---|---|
| Provider Enumeration Date | 12/16/2020 |
| Last Update Date | 10/10/2023 |
| Medicare PECOS PAC ID | 7012322761 |
|---|---|
| Medicare Enrollment ID | O20210210003366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043806730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Blake Putman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659784338 PECOS PAC ID: 3870884547 Enrollment ID: I20171005002403 |
| Provider Name | Heather Anna-donna Wilson-vani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407508781 PECOS PAC ID: 0143690313 Enrollment ID: I20230626000715 |
| Provider Name | Kaitlyn E Mcintosh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427642875 PECOS PAC ID: 6305254236 Enrollment ID: I20230802001707 |
| Provider Name | Lindsay Bissett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346965340 PECOS PAC ID: 6507227881 Enrollment ID: I20230802004027 |
| Provider Name | Joshuah Edward Guigar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952024747 PECOS PAC ID: 5799139911 Enrollment ID: I20230921002947 |
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