Healthcare Provider Details

I. General information

NPI: 1891763306
Provider Name (Legal Business Name): RENU CHATURVEDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 DELHI COMMERCE DR SUITE 4
HOLT MI
48842-2193
US

IV. Provider business mailing address

4454 SENECA DR
OKEMOS MI
48864-2946
US

V. Phone/Fax

Practice location:
  • Phone: 517-699-3820
  • Fax: 517-699-3824
Mailing address:
  • Phone: 517-381-4698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301077061
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: