Healthcare Provider Details

I. General information

NPI: 1306186861
Provider Name (Legal Business Name): YAMINI SATISH KAPILESHWARKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YAMINI RAJKANAN

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 06/17/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST SUITE 4105
DETROIT MI
48201-2119
US

IV. Provider business mailing address

3901 BEAUBIEN ST SUITE 4105
DETROIT MI
48201-2119
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-0122
  • Fax:
Mailing address:
  • Phone: 313-745-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301102217
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberC171969
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036146959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: