Provider Demographics
NPI:1174976740
Name:NICOLE SAPIRO VINCKIER
Entity type:Organization
Organization Name:NICOLE SAPIRO VINCKIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-647-9860
Mailing Address - Street 1:1307 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7090
Mailing Address - Country:US
Mailing Address - Phone:818-726-3262
Mailing Address - Fax:
Practice Address - Street 1:35046 WOODWARD AVE
Practice Address - Street 2:STE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-0964
Practice Address - Country:US
Practice Address - Phone:248-647-9860
Practice Address - Fax:248-647-9864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATIONS OB-GYN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty