Provider Demographics
NPI:1336636786
Name:VEIN CENTER AT ALLURE MEDICAL SPA, PLLC
Entity type:Organization
Organization Name:VEIN CENTER AT ALLURE MEDICAL SPA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-992-8300
Mailing Address - Street 1:8180 26 MILE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5139
Mailing Address - Country:US
Mailing Address - Phone:586-786-5900
Mailing Address - Fax:586-992-9331
Practice Address - Street 1:369 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3405
Practice Address - Country:US
Practice Address - Phone:800-577-2570
Practice Address - Fax:586-992-2830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VEIN CENTER AT ALLURE MEDCIAL SPA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-20
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty