Healthcare Provider Details

I. General information

NPI: 1447629795
Provider Name (Legal Business Name): SOHAM TRIVEDI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 GENERAL DR UNIT 100
PLYMOUTH MI
48170-4628
US

IV. Provider business mailing address

29866 HEMLOCK AVE
FARMINGTON HILLS MI
48336-2055
US

V. Phone/Fax

Practice location:
  • Phone: 734-335-1336
  • Fax: 734-392-8780
Mailing address:
  • Phone: 248-228-4402
  • Fax: 734-392-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007470
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: