Organization
PETER S VASIU DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY J DEGOOD (OFFICE MANAGER)
(616) 281-7000
Entity
Organization
Contact information
Practice address
2591 44TH ST SE, SUITE 103, KENTWOOD, MI 49512-9094
(616) 281-7000
Mailing address
2591 44TH ST SE, SUITE 103, KENTWOOD, MI 49512-9094
(616) 281-7000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
5101012366
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2054102165
BLUE CROSS BLUE SHIELD
MI
05
—
4521418
—
MI
Enumeration date
04/17/2008
Last updated
10/07/2010
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