Normita Davila Vicencio, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

NV032288 Issued in MI

Practice address

4020 Venoy Road
Suite 300
Wayne, MI 48184

Phone

(734) 728-2909

Fax

(734) 728-3015

NPI assigned

Oct 6, 2006

Last updated

Aug 8, 2007By the provider in NPPES

Sex

Female

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 3

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Normita Vicencio MD PC

  • Internal Medicine Physician
  • Wayne, MI
  • NPI 1841493616
  Authorized official Same address or phone
• Wafa a Elhassan MD PLLC

  • Integrative Medicine Physician
  • Wayne, MI
  • NPI 1609425180
  NPD

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186531200000",
    "number": "1700973385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 VENOY ROAD",
            "address_2": "SUITE 300",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "48184",
            "telephone_number": "734-728-2909",
            "fax_number": "734-728-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 VENOY ROAD",
            "address_2": "SUITE 300",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "48184",
            "telephone_number": "734-728-2909",
            "fax_number": "734-728-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICENCIO",
        "first_name": "NORMITA",
        "middle_name": "DAVILA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "NV032288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170375810",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "1108258662",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "110154734",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valley Medical Pharmacy LLC (Venoy Pharmacy)
• Beck Vanamberg
• Vantage Pharmaceutical Services
• Stephen Venable, MD, MPH, RN
• Michelle Anne Vernier, CRNA
• Victory Care Clinic
• Victory Care Clinic
• Puthenparampil G Vijayakumaran, MD
• Vishnu Pemmaraju, MD
• Shawna Viskantas

• Internal Medicine Physician in Wayne, MI
• Providers in Wayne, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.