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General NPI Number Information
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NPI Number | 1447629795
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Entity Type | Individual
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Provider Name | SOHAM TRIVEDI PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 16001 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 248-849-5806
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Fax | 248-849-5489
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Provider Business Mailing Address
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Address Line | 29866 HEMLOCK AVE
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-2055
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Country | US
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Telephone | 248-228-4402
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601007470
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License Number State | MI
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