Provider Demographics
NPI:1700143484
Name:VITALITY NUTRITION
Entity type:Organization
Organization Name:VITALITY NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPILA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:248-961-0229
Mailing Address - Street 1:43155 MAIN ST
Mailing Address - Street 2:SUITE 305 B-1
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1777
Mailing Address - Country:US
Mailing Address - Phone:248-961-0229
Mailing Address - Fax:
Practice Address - Street 1:43155 MAIN ST
Practice Address - Street 2:SUITE 305 B-1
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1777
Practice Address - Country:US
Practice Address - Phone:248-961-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI913707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID #