Healthcare Provider Details

I. General information

NPI: 1932132958
Provider Name (Legal Business Name): RAHUL VAIDYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST
DETROIT MI
48201
US

IV. Provider business mailing address

311 MACK AVE FL 5
DETROIT MI
48201-2466
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3000
  • Fax:
Mailing address:
  • Phone: 313-832-0500
  • Fax: 313-745-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number4301076989
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number4301076989
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301076989
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: