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Organization
NORMITA VICENCIO MD PC
Active
Organization
NORMITA VICENCIO MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NORMITA VICENCIO M.D. (OWNER)
(734) 728-2909
Entity
Organization
Contact information
Practice address
4020 VENOY RD STE 300, WAYNE, MI 48184-1899
(734) 728-2909
Mailing address
4020 VENOY RD STE 300, WAYNE, MI 48184-1899
(734) 728-2909
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
NV032288
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101703758
—
MI
01
—
108010
CARE CHOICES
MI
01
—
110154734
MEDICARE RAILROAD
MI
01
—
1108258662
BCBSM
MI
01
—
C5295
MCARE
MI
Enumeration date
06/07/2007
Last updated
10/08/2014
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