Provider Demographics
NPI:1689496820
Name:VIP HOME PHYSICIANS PLLC
Entity type:Organization
Organization Name:VIP HOME PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALAJAC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-600-6328
Mailing Address - Street 1:17425 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1437
Mailing Address - Country:US
Mailing Address - Phone:313-499-8991
Mailing Address - Fax:313-499-8938
Practice Address - Street 1:17425 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1437
Practice Address - Country:US
Practice Address - Phone:313-499-8991
Practice Address - Fax:313-499-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty