Provider Demographics
NPI:1992900369
Name:SAN JOSE, VIRGILIO Z (MD)
Entity type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:Z
Last Name:SAN JOSE
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 1:550 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1109
Mailing Address - Country:US
Mailing Address - Phone:248-733-7300
Mailing Address - Fax:248-733-7301
Practice Address - Street 1:550 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1109
Practice Address - Country:US
Practice Address - Phone:248-733-7300
Practice Address - Fax:248-733-7301
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine