Provider Demographics
NPI:1447064274
Name:MDVIP OF TROY LLC
Entity type:Organization
Organization Name:MDVIP OF TROY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-808-6012
Mailing Address - Street 1:1800 W BIG BEAVER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3535
Mailing Address - Country:US
Mailing Address - Phone:248-808-6012
Mailing Address - Fax:
Practice Address - Street 1:1639 E BIG BEAVER RD STE 202
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2054
Practice Address - Country:US
Practice Address - Phone:248-606-4190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty