Provider Demographics
NPI:1871720342
Name:VERNOR MC INC
Entity type:Organization
Organization Name:VERNOR MC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ZULMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-841-0395
Mailing Address - Street 1:7649 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-1513
Mailing Address - Country:US
Mailing Address - Phone:313-841-0395
Mailing Address - Fax:
Practice Address - Street 1:7649 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-1513
Practice Address - Country:US
Practice Address - Phone:313-841-0395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3469082Medicaid
MIE31091Medicare UPIN
MI3469082Medicaid