Healthcare Provider Details

I. General information

NPI: 1265986806
Provider Name (Legal Business Name): XAVIER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD STE 115
BINGHAM FARMS MI
48025-4302
US

IV. Provider business mailing address

6632 TELEGRAPH RD 204
BLOOMFIELD MI
48301-3012
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA AMUDHA XAVIER
Title or Position: PRESIDENT
Credential:
Phone: 248-621-9200