Healthcare Provider Details

I. General information

NPI: 1891538120
Provider Name (Legal Business Name): VADIM KRYLOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W. 13 MILE RD COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL
ROYAL OAK MI
48073
US

IV. Provider business mailing address

P.O. BOX 3601 W. 13 MILE RD COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3000
  • Fax: 248-551-2032
Mailing address:
  • Phone: 248-551-3000
  • Fax: 248-551-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351052391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: