Northern Michigan Vascular Lab PC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

NORTHERN MICHIGAN VASCULAR LAB PC

Practice address

3930 Cedar Run Rd
Traverse City, MI 49684-9687

Phone

(231) 935-0390

Fax

(231) 935-0395

NPI assigned

Jan 30, 2008

Last updated

Apr 9, 2008By 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

Locations

Practitioners 1

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
  NPD (past) Authorized official

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1548447683",
    "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 LAB PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2008-04-09",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern Michigan Pediatric Dentistry
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• Northern Michigan Vascular Center P.C.
• 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
• Northway and Hall Orthodontics 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 Apr 9, 2008; 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.