Vaughn, Michael Derek

Vaughn, Michael Derek is an individual health care provider with primary practice located at 1970 S Ridge Rd , Green Bay WI 54304-4125. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Hand Surgery. Allopathic & Osteopathic Physicians / Hand Surgery is his primary health care specialty. Vaughn, Michael Derek can be contacted via phone (920) 430-4888.

Contact Information

Primary practice address
1970 S Ridge Rd Green Bay WI 54304-4125
Phone: (920) 430-4888
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X Ohio
Allopathic & Osteopathic Physicians / Hand Surgery 207XS0106X 73428-20 Wisconsin

Profile Details

NPI number 1427476969
LBN Legal business name Vaughn, Michael Derek
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 2nd, 2014
Last updated Aug 3rd, 2020 - about 4 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 1427476969 NPPES
Ohio MEDICAID 0128762

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