| NPI | 1326587114 |
|---|---|
| Doing Business As | MED SPORTS VANTAGE PLLC |
| Doing Business As | MED SPORTS VANTAGE |
| Entity Type | Organization |
| Authorized Contact | RACHEL LETHORN CEO / Owner 810-626-3036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MI 5601003608) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: MI 5601003608) | |
| 363A00000X Physician Assistant (Licence: MI 5601003608) | |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2023-03-25 |