Healthcare Provider Details

I. General information

NPI: 1740570811
Provider Name (Legal Business Name): VINAYA K. GAVINI MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 N SILVERY LN SUITE 101
DEARBORN HEIGHTS MI
48127-4510
US

IV. Provider business mailing address

8550 N SILVERY LN SUITE 101
DEARBORN HEIGHTS MI
48127-4510
US

V. Phone/Fax

Practice location:
  • Phone: 313-730-7007
  • Fax: 313-730-7002
Mailing address:
  • Phone: 313-730-7007
  • Fax: 313-730-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301037182
License Number StateMI

VIII. Authorized Official

Name: DR. VINAYA KUMAR GAVINI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 313-595-8304