Healthcare Provider Details

I. General information

NPI: 1386635241
Provider Name (Legal Business Name): GITA K VORA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 S LAPEER RD SUITE 122
LAKE ORION MI
48360-1467
US

IV. Provider business mailing address

1455 S LAPEER RD SUITE 122
LAKE ORION MI
48360-1467
US

V. Phone/Fax

Practice location:
  • Phone: 248-627-2881
  • Fax: 248-232-9908
Mailing address:
  • Phone: 248-627-2881
  • Fax: 248-232-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301031637
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: