Organization
VITAL MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERBERT ISSAC MD (OWNER)
(313) 463-8676
Entity
Organization
Contact information
Practice address
35 S JOHNSON ST STE 1B, PONTIAC, MI 48341-1660
(313) 463-8676
Mailing address
35 S JOHNSON ST STE 1B, PONTIAC, MI 48341-1660
(313) 463-8676
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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