Medalle, Vicente M

Medalle, Vicente M is an individual health care provider with primary practice located at 1460 N Center Rd , Burton MI 48509-1429. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Emergency Medical Services. Allopathic & Osteopathic Physicians / Emergency Medical Services is his primary health care specialty. Medalle, Vicente M can be contacted via phone (810) 715-4620.

Contact Information

Primary practice address
1460 N Center Rd Burton MI 48509-1429
Phone: (810) 715-4620
Fax: (810) 715-4602
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 4301033720 Michigan
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 4301033720 Michigan

Profile Details

NPI number 1578546529
LBN Legal business name Medalle, Vicente M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 23rd, 2005
Last updated Sep 30th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578546529 NPPES
Other VM033720 BLUE CROSS BLUE SHIELD
Other P00213537 BLUE CROSS BLUE SHIELD
MEDICAID 3332980 BLUE CROSS BLUE SHIELD
MEDICAID 3332962 BLUE CROSS BLUE SHIELD
MEDICAID 3332971 BLUE CROSS BLUE SHIELD

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