Individual
AILEEN JO VITANGCOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2002 S 11TH ST, NILES, MI 49120-4074
(269) 687-0200
(269) 684-0199
Mailing address
2002 S 11TH ST, NILES, MI 49120-4074
(269) 687-0200
(269) 684-0199
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301093128
MI
208000000X
Pediatrics Physician
A97605
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457567935
—
MI
Enumeration date
05/14/2007
Last updated
04/17/2013
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