Provider Demographics
NPI:1144007436
Name:AEVITAS MEDICAL CONSULTANTS PLC
Entity type:Organization
Organization Name:AEVITAS MEDICAL CONSULTANTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-229-8323
Mailing Address - Street 1:109 E FRONT ST STE 210
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5705
Mailing Address - Country:US
Mailing Address - Phone:248-229-8323
Mailing Address - Fax:231-346-6051
Practice Address - Street 1:109 E FRONT ST STE 210
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5705
Practice Address - Country:US
Practice Address - Phone:248-229-8323
Practice Address - Fax:231-346-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty