Provider Demographics
NPI:1598828113
Name:DARIAN, VIGEN (MD)
Entity type:Individual
Prefix:
First Name:VIGEN
Middle Name:
Last Name:DARIAN
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:6777 WEST MAPLE ROAD
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323
Mailing Address - Country:US
Mailing Address - Phone:248-661-6450
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:6777 WEST MAPLE ROAD
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323
Practice Address - Country:US
Practice Address - Phone:248-661-6450
Practice Address - Fax:248-661-6649
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407274207Y00000X, 208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VD407274OtherCOMMERCIAL-COMMERCIAL NUMBER
VD407274OtherCHAMPUS-CHAMPUS
F01762Medicare UPIN