Individual
ROBERT G VACLAV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
19020 FORT ST, RIVERVIEW, MI 48193-6701
(734) 362-5100
(734) 362-5147
Mailing address
19020 FORT ST, RIVERVIEW, MI 48193-6701
(734) 362-5100
(734) 362-5147
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
5101006380
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125103
MERCY CARE CHOICES
MI
01
—
292373
UHC
MI
05
—
3221631
—
MI
01
—
4037350
AETNA
MI
01
—
5101006380
PHYSICIAN LICENSE
MI
01
—
700H21076
BCBSM
MI
01
—
8061647
CIGAN
MI
01
—
C4684
MCARE
MI
01
—
CC33713
RR MEDICARE
MI
Enumeration date
05/22/2006
Last updated
02/25/2010
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