Provider Demographics
NPI:1447899117
Name:VITAL CLINIC AND SPA, PLLC
Entity type:Organization
Organization Name:VITAL CLINIC AND SPA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HARMANPREET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:BUTTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-613-5707
Mailing Address - Street 1:11327 CYPRESS CREEK LAKES DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2336
Mailing Address - Country:US
Mailing Address - Phone:832-613-5707
Mailing Address - Fax:888-668-4625
Practice Address - Street 1:11004 GRANT RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2900
Practice Address - Country:US
Practice Address - Phone:832-533-8404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty