Please use this form to notify HVPA of any changes to practice or physician information. Upon receipt, we will also notify participating health plans of any changes. If you are changing your tax ID number, please be sure to also fax a completed W-9 form to 734-975-1248. All changes will become effective within 30 days of submission.
If you have any questions or concerns, please contact Tracy O'Brien, Provider Relations at 734-973-0137 ext. 414.