Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5951001393 | MI |
Y | 222Z00000X | Podiatrist | 5951001393 | MI |
NPI | 1063037075 |
---|---|
Provider Name | Vikrant Wadehra |
First Address | Southfield, MI 48075-4818 |
Second Address | Farmington Hills, MI 48334-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2020 |
Last Update Date | 15/06/2020 |