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General NPI Number Information
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NPI Number | 1326160433
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Entity Type | Organization
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Legal Business Name | BEECH DALY MEDICAL CENTER, PLLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 23850 VAN BORN RD
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-2325
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Country | US
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Telephone | 313-278-7750
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Fax | 313-278-8729
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Provider Business Mailing Address
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Address Line | 23850 VANBRON
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-2325
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Country | US
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Telephone | 313-278-7750
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Fax | 313-278-8729
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIJAYALAKSMI THANDRA
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Credential | MD
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Telephone | 313-278-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301058459
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License Number State | MI
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