Provider Demographics
NPI:1174597991
Name:CAREY M VIGOR MD PC
Entity type:Organization
Organization Name:CAREY M VIGOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VIGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-615-4323
Mailing Address - Street 1:18530 MACK AVE
Mailing Address - Street 2:# 478
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3254
Mailing Address - Country:US
Mailing Address - Phone:586-615-4323
Mailing Address - Fax:810-794-1844
Practice Address - Street 1:2725 PACKARD RD
Practice Address - Street 2:# 101
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3443
Practice Address - Country:US
Practice Address - Phone:586-615-4323
Practice Address - Fax:810-794-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010393922084N0600X, 208VP0000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N97360Medicare PIN
A49483Medicare UPIN
INM100063500Medicare PIN
MIN97360-001Medicare PIN