Northern Michigan Vascular Center P.C.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

4301079215 Issued in MI

Legal business name

NORTHERN MICHIGAN VASCULAR CENTER P.C.

Practice address

3930 Cedar Run Rd
Traverse City, MI 49684-9687

Phone

(231) 935-0390

Fax

(231) 935-0395

NPI assigned

Nov 2, 2007

Last updated

Mar 2, 2021By 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. Michael David Colburn, M.D.NPI 1760486260

Title

President

Phone

(231) 935-0390

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 5

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.

• Michael D Colburn

  • Vascular Surgery Physician
  • Traverse City, MI
  • NPI 1760486260
  Medicare reassignment NPD Authorized official
• Michael John Boros, MD

  • Surgery Physician
  • Traverse City, MI
  • NPI 1942403159

  Vascular Surgery

  Medicare reassignment NPD
• Lauren Cardella, DO

  • Vascular Surgery Physician
  • Traverse City, MI
  • NPI 1275950347
  Medicare reassignment NPD
• Steven D Rimar, MD

  • Vascular Surgery Physician
  • Grosse Pointe, MI
  • NPI 1205818994
  Medicare reassignment NPD
• Matthew George Roos, M.D.

  • Vascular Surgery Physician
  • Traverse City, MI
  • NPI 1982847489
  Medicare reassignment NPD

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

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1093994337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 CEDAR RUN RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849687",
            "telephone_number": "231-935-0390",
            "fax_number": "231-935-0395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 CEDAR RUN RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849687",
            "telephone_number": "231-935-0390",
            "fax_number": "231-935-0395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MICHIGAN VASCULAR CENTER P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "COLBURN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-935-0390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301079215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.colburn@vconm.eclinicaldirectplus",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3930 Cedar Run Rd",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496849687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Northern Michigan Medicine and Pediatrics, PLLC
• Northern Michigan Pediatric Dentistry
• Northern Michigan Plastic Surgery PC
• Northern Michigan Psychiatric Services
• Northern Michigan Psychiatric Services PC
• Northern Michigan Vascular Lab PC
• Northern Roots Medical Associates P.L.L.C. (Northern Roots Wellness and Medicine)
• Northern Vision Eye Care, PC
• Northern Woods Counseling & Consulting Services, Inc.
• Northshore Rehab PLLC

• Vascular Surgery Physician in Traverse City, MI
• Providers in Traverse City, 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 Mar 2, 2021; 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.