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General NPI Number Information
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NPI Number | 1346774981
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Entity Type | Individual
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Provider Name | MARVIN LAITH KAJY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 100 MICHIGAN ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone | 248-483-1731
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Fax |
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Provider Business Mailing Address
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Address Line | 28632 APPLEBLOSSOM LN
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-2403
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Country | US
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Telephone | 248-483-1731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4301501728
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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