MEDICARE: MR. SMITKUMAR KADAKIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302036220	MI

General Provider Information

NPI Number	:	1568747079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SMITKUMAR KADAKIA

Provider Business Mailing Address
First Line	:	22950 VAN DYKE AVE
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-2346
Country	:	US
Telephone Number	:	586-759-1391
Fax Number	:	586-759-4347

Provider Business Practice Location Address
First Line	:	13901 METROPOLITAN PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-3401
Country	:	US
Telephone Number	:	586-446-8770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2011
Last Update Date	:	12/21/2022

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