Brad E Vazales, M.D.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

4301073933 Issued in MI

Practice address

2390 Mitchell Park Dr
Suite B
Petoskey, MI 49770-8965

Phone

(231) 487-9090

Fax

(231) 487-9191

NPI assigned

May 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Vein Center and Medical Spa

  • Vascular Surgery Physician
  • Traverse City, MI
  • NPI 1740358209
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255996800000",
    "number": "1366495285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2390 MITCHELL PARK DR",
            "address_2": "SUITE B",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708965",
            "telephone_number": "231-487-9090",
            "fax_number": "231-487-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2390 MITCHELL PARK DR",
            "address_2": "SUITE B",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708965",
            "telephone_number": "231-487-9090",
            "fax_number": "231-487-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAZALES",
        "first_name": "BRAD",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2009-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MI",
            "license": "4301073933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4319099",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "780001998",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke M Vandonkelaar, CCC-SLP
• Ken Vanevery, CADC
• Timothy Vanevery, M.D.
• Tanya Vanillo
• Raquel Vansickle, LLMSW
• Kenneth W Verbos II, MD
• Daniel J Verburg, MD
• Lori Vezina
• Matthew L Visconti, M.D.
• Vision Max PC

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; 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.