Vitalis Im

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

3150 Packard Rd
Ypsilanti, MI 48197-1994

Phone

(248) 581-8777

NPI assigned

Dec 12, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Patchwork Psychotherapy LLC

  • Clinical Social Worker
  • Ann Arbor, MI
  • NPI 1003703661
  NPD Authorized official
• Fairsky Foundation

  • Multi-Specialty Clinic/Center
  • Ferndale, MI
  • NPI 1033595665

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1003402207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 W GRAND RIVER AVE STE A",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488641604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 PACKARD RD",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971994",
            "telephone_number": "248-581-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IM",
        "first_name": "VITALIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-12",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801120101",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iha Health Services Organization
• Iha of Ann Arbor PC
• Iha of Ann Arbor PC
• Adam Lucas Ihrig, PA-C
• Susan R. Illikman, N.P.
• Zainab Imami
• Christina Juliana Imlinger, MD
• Mahnoor Inamullah, M.D.
• Independent Helping Hands Service
• Infectious Diseases Associates, P.C.

• Clinical Social Worker in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.