Healthcare Provider Details

I. General information

NPI: 1447219365
Provider Name (Legal Business Name): VASUDEV R GARLAPATY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 NORTHLINE RD
SOUTHGATE MI
48195-2402
US

IV. Provider business mailing address

1640 FORT ST SUITE D ATTN DENISE
TRENTON MI
48183-2040
US

V. Phone/Fax

Practice location:
  • Phone: 734-281-4197
  • Fax: 734-282-0093
Mailing address:
  • Phone: 734-391-3057
  • Fax: 734-391-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME111983
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301039321
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: