Active NPI
Vitality Health Clinic PLLC
- Family Medicine Physician
- Dearborn Heights, MI
National Provider Identifier
1689430407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- VITALITY HEALTH CLINIC PLLC
- Practice address
- 4245 S Beech Daly St Ste 102
Dearborn Heights, MI 48125-1576 - Phone
- (313) 414-0703
- NPI assigned
- Feb 28, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Rawya Kazan, AGPCNP-BC
- Title
- Nurse Practitioner
- Phone
- (313) 414-0703
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
4245 S Beech Daly St Ste 102
Dearborn Heights, MI 48125-1576
Mailing address
4245 S Beech Daly St
Dearborn Heights, MI 48125-1576
Phone (313) 414-0703
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240408000597 | MI | Part B Supplier - Clinic/Group Practice | 7911345103 |
Receives reassigned benefits from 3 practitioners Practice locations: Dearborn Heights, MI |
National Provider Directory
National Provider Directory- Tax ID family
- Vitality Health Clinic
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Clinic/Center
- Dearborn Heights, MI
- NPI 1760248587
Locations
4245 S Beech Daly St
Ste 102
Dearborn Heights, MI 48125
Phone (313) 414-0703
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709078400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1713398400000",
"number": "1689430407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4245 S BEECH DALY ST",
"city": "DEARBORN HEIGHTS",
"state": "MI",
"postal_code": "481251576",
"telephone_number": "313-414-0703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4245 S BEECH DALY ST STE 102",
"city": "DEARBORN HEIGHTS",
"state": "MI",
"postal_code": "481251576",
"telephone_number": "313-414-0703"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VITALITY HEALTH CLINIC PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-02-28",
"last_updated": "2024-04-18",
"certification_date": "2024-04-18",
"status": "A",
"authorized_official_last_name": "KAZAN",
"authorized_official_first_name": "RAWYA",
"authorized_official_title_or_position": "NURSE PRACTITIONER",
"authorized_official_telephone_number": "313-414-0703",
"authorized_official_credential": "AGPCNP-BC"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn Heights, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; 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.