Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301100662 | MI |
Y | 2080P0205X | Pediatric Endocrinologist | 4301100662 | MI |
NPI | 1376893487 |
---|---|
Provider Name | Aditya Vinayak Dewoolkar |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2012 |
Last Update Date | 02/03/2021 |