Healthcare Provider Details

I. General information

NPI: 1093101685
Provider Name (Legal Business Name): HITESH VASHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PINE GROVE AVE
PORT HURON MI
48060
US

IV. Provider business mailing address

1465 S GRAND BLVD ROOM 2717
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301115592
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: