Provider Demographics
NPI:1740162973
Name:RADIANT VASCULAR INSTITUTE PC
Entity type:Organization
Organization Name:RADIANT VASCULAR INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERMENTROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-206-3551
Mailing Address - Street 1:25500 MEADOWBROOK RD STE 115
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25500 MEADOWBROOK RD STE 115
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1879
Practice Address - Country:US
Practice Address - Phone:616-206-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology