Healthcare Provider Details

I. General information

NPI: 1962457705
Provider Name (Legal Business Name): LAXMIGI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 WOODWARD AVE
HIGHLAND PARK MI
48203-3607
US

IV. Provider business mailing address

13111 WOODWARD AVE
HIGHLAND PARK MI
48203-3607
US

V. Phone/Fax

Practice location:
  • Phone: 313-865-9494
  • Fax: 313-883-8125
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008361
License Number StateMI

VIII. Authorized Official

Name: VINOD BHAI
Title or Position: PRESIDENT
Credential:
Phone: 313-865-9494