Healthcare Provider Details

I. General information

NPI: 1992390975
Provider Name (Legal Business Name): VK IATROS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE FL LABOR3
NOVI MI
48374-1233
US

IV. Provider business mailing address

24789 TODDY LN
FARMINGTON HILLS MI
48335-2075
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-3884
  • Fax:
Mailing address:
  • Phone: 248-910-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIJAYAKIRAN KAZA
Title or Position: ORGANIZER
Credential: M.D
Phone: 248-910-3884