Provider Demographics
NPI:1245916709
Name:ACV TRAVERSE CITY PLLC
Entity type:Organization
Organization Name:ACV TRAVERSE CITY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORPUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-342-5088
Mailing Address - Street 1:1525 E BELTLINE AVE NE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4598
Mailing Address - Country:US
Mailing Address - Phone:616-644-3102
Mailing Address - Fax:231-252-0416
Practice Address - Street 1:3865 W FRONT ST STE 4AND5
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8101
Practice Address - Country:US
Practice Address - Phone:231-252-0414
Practice Address - Fax:231-252-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty