Michigan Vascular Institute PLLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

5101007182 Issued in MI

Legal business name

MICHIGAN VASCULAR INSTITUTE PLLC

Practice address

538 N Old Woodward Ave
Birmingham, MI 48009-5375

Phone

(248) 594-3091

Fax

(248) 594-3068

NPI assigned

Jul 19, 2007

Last updated

Feb 23, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gregory P. Derderian, D.O.NPI 1457355737

Title

Member

Phone

(248) 594-3091

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EIGBDA

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gregory Paul Derderian, D.O.

  • Vascular Surgery Physician
  • Birmingham, MI
  • NPI 1457355737
  Medicare reassignment NPD Authorized official
• James Peter Caralis, D.O.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Pontiac, MI
  • NPI 1902829930
  NPD (past)

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1093915910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N OLD WOODWARD AVE",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480095375",
            "telephone_number": "248-594-3091",
            "fax_number": "248-594-3068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 N OLD WOODWARD AVE",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480095375",
            "telephone_number": "248-594-3091",
            "fax_number": "248-594-3068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN VASCULAR INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "DERDERIAN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "248-594-3091",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "5101007182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Warren Therapy
• Michigan Infertility Center PC
• Michigan Ophthalmology Specialists, PLLC
• Michigan Orthopaedic Rehabilitation
• Michigan Spine Consultants PLLC
• Michigan Wound Care Plus PC
• Hayley Marie Mieras, MT-BC
• David G. Mikkola, LMSW
• Mitchell S. Milan, D.D.S.
• Michael Joseph Miletic, MD

• Vascular Surgery Physician in Birmingham, MI
• Providers in Birmingham, MI by specialty
• Vascular Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.