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General NPI Number Information
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NPI Number | 1437275765
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Entity Type | Organization
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Legal Business Name | FIRST OPTION MEDICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 4215 S BEECH DALY ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-1567
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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 | 4215 S BEECH DALY ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-1567
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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. VIJAYLAKSMI THANDRA
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Credential | M.D
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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