Organization
ELCTRODIAGNOSTIC MEDICINE CONSULTANTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK MICHAEL VINCENT SR. M.D. (OWNER/PHYSICIAN)
(517) 374-1055
Entity
Organization
Contact information
Practice address
1515 LAKE LANSING RD, SUITE F-1, LANSING, MI 48912-3753
(517) 374-1055
(517) 374-1061
Mailing address
1515 LAKE LANSING RD, SUITE F-1, LANSING, MI 48912-3753
(517) 374-1055
(517) 374-1061
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
4301035133
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0331291
MEDICARE ID-TYPE UNSPECIFIED
MI
05
—
1687260
—
MI
Enumeration date
05/20/2008
Last updated
05/20/2008
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