| Organization Name: | MICHIGAN VASCULAR INSTITUTE PLLC |
| NPI Number: | 1093915910 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY P. DERDERIAN (PRESIDENT) |
| Mailing Address: | 1030 Harrington St Suite 103 Mount Clemens |
| State: | MI US |
| Postal Code: | 480432967 |
| Phone Number: | 5864933175 |
| Fax Number: | 5864933828 |
| NPI Enumeration Date: | 07/19/2007 |
| NPI Last Update Date: | 07/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | 5101007182 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |