Provider Demographics
NPI:1447423439
Name:FEMME VITALE, PLC
Entity type:Organization
Organization Name:FEMME VITALE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CHRISTIE
Authorized Official - Last Name:CAIRNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-982-3366
Mailing Address - Street 1:431 UPTON DR
Mailing Address - Street 2:EDGEWATER CENTER
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1058
Mailing Address - Country:US
Mailing Address - Phone:269-982-3366
Mailing Address - Fax:
Practice Address - Street 1:431 UPTON DR
Practice Address - Street 2:EDGEWATER CENTER
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1058
Practice Address - Country:US
Practice Address - Phone:269-982-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049836207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0111070OtherBLUE CROSS BLUE SHIELD MI
MI0P24300Medicare PIN
MI0111070OtherBLUE CROSS BLUE SHIELD MI