Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M1813 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | M1813 | TX |
N | 207R00000X | Internist | 5101014427 | MI |
N | 111NI0900X | Internist | 5101014427 | MI |
N | 207R00000X | Internist | M1813 | TX |
N | 111NI0900X | Internist | M1813 | TX |
NPI | 1275595167 |
---|---|
Provider Name | Vinay Madhukar Kamble |
First Address | Troy, MI 48099-1239 |
Second Address | Austin, TX 78757-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 14/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4472251 | (05) | MI |
H77766 | (02) |