Organization
INTERNAL MEDICINE AND VITALITY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMANDA R HENRY DO (OWNER)
(269) 762-4120
Entity
Organization
Contact information
Practice address
6505 CONSTITUTION BLVD STE C, PORTAGE, MI 49024-1605
(269) 762-4120
(269) 254-8413
Mailing address
6505 CONSTITUTION BLVD STE C, PORTAGE, MI 49024-1605
(269) 762-4120
(269) 254-8413
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
06/19/2024
Last updated
01/06/2025
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