# NORTHERN MICHIGAN VASCULAR LAB PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548447683
- **Authorized official:** DR. MICHAEL DAVID COLBURN M.D. (PRESIDENT)
- **Authorized official phone:** (231) 935-0390

## Contact information

- **Practice address:** 3930 CEDAR RUN RD, TRAVERSE CITY, MI 49684-9687
- **Practice address phone:** (231) 935-0390
- **Practice address fax:** (231) 935-0395
- **Mailing address:** 3930 CEDAR RUN RD, TRAVERSE CITY, MI 49684-9687
- **Mailing address phone:** (231) 935-0390
- **Mailing address fax:** (231) 935-0395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/30/2008
- **Last updated:** 04/09/2008