Provider Demographics
NPI:1679734461
Name:VISITING PHYSICIANS ASSOCIATES PC
Entity type:Organization
Organization Name:VISITING PHYSICIANS ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAZLOLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-477-9030
Mailing Address - Street 1:3150 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1994
Mailing Address - Country:US
Mailing Address - Phone:734-477-9030
Mailing Address - Fax:734-477-9032
Practice Address - Street 1:3150 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1994
Practice Address - Country:US
Practice Address - Phone:734-477-9030
Practice Address - Fax:734-477-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID92498Medicare UPIN