Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301089848 | MI |
NPI | 1366628703 |
---|---|
Provider Name | Gargi Vidholia |
First Address | Grosse Pointe Farms, MI 48236-3610 |
Second Address | Grosse Pointe Farms, MI 48236-3610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2008 |
Last Update Date | 12/03/2013 |