Healthcare Provider Details

I. General information

NPI: 1154828036
Provider Name (Legal Business Name): ROHAN PRAVEEN KEDAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 N CANTON CENTER RD STE 900
CANTON MI
48187-2740
US

IV. Provider business mailing address

5958 N CANTON CENTER RD STE 900
CANTON MI
48187-2740
US

V. Phone/Fax

Practice location:
  • Phone: 734-786-2300
  • Fax: 734-786-4915
Mailing address:
  • Phone: 734-737-1200
  • Fax: 734-737-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301503381
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: