| Vitality Wellness And Medspa Pllc | |
|
24464 Thatcher Dr Novi MI 48375-2365 | |
| (617) 549-0252 | |
| Not Available |
| Full Name | Vitality Wellness And Medspa Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 24464 Thatcher Dr, Novi, Michigan |
| Authorized Official Name and Position | Komal Trivedi (OWNER) |
| Authorized Official Contact | 6175490252 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Wellness And Medspa Pllc 24464 Thatcher Dr Novi MI 48375-2365 Ph: (617) 549-0252 | Vitality Wellness And Medspa Pllc 24464 Thatcher Dr Novi MI 48375-2365 Ph: (617) 549-0252 |
| NPI Number | 1558959247 |
|---|---|
| Provider Enumeration Date | 01/07/2021 |
| Last Update Date | 08/19/2024 |
| Medicare PECOS PAC ID | 0547676231 |
|---|---|
| Medicare Enrollment ID | O20210303002644 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558959247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Komal A Trivedi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679736565 PECOS PAC ID: 6800065178 Enrollment ID: I20110803000724 |
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