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General NPI Number Information
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NPI Number | 1033370648
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Entity Type | Organization
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Legal Business Name | MEDFIX P.C.
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 47601 GRAND RIVER AVE SUITE B-230
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City | NOVI
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State | MI
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Zip | 48374-1233
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Country | US
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Telephone | 248-465-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 25020 HADLOCK DR
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City | NOVI
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State | MI
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Zip | 48374-2553
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Country | US
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Telephone | 877-545-3297
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NISHA CHELLAM VEDAMUTHU
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Credential | M.D.
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Telephone | 877-545-3297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301061862
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License Number State | MI
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