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General NPI Number Information
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NPI Number | 1558082198
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Entity Type | Individual
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Provider Name | ANI GVAJAIA
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 22101 MOROSS RD
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City | DETROIT
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State | MI
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Zip | 48236-2148
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Country | US
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Telephone | 313-343-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1695 E 21ST ST APT E3
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City | BROOKLYN
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State | NY
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Zip | 11210-5026
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Country | US
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Telephone | 929-428-9272
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 4351054747
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License Number State | MI
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