Provider Demographics
NPI:1124078068
Name:VIX, STEVEN A (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:VIX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W HARRIE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868-1200
Mailing Address - Country:US
Mailing Address - Phone:906-293-5147
Mailing Address - Fax:
Practice Address - Street 1:504 W HARRIE ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-1200
Practice Address - Country:US
Practice Address - Phone:906-293-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102594710Medicaid
MI1104800062OtherBLUE CROSS BLUE SHIELD MI
MI104926247Medicaid
MIF00393Medicare UPIN
MI104926247Medicaid