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General NPI Number Information
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NPI Number | 1710953666
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Entity Type | Individual
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Provider Name | VIJIL K RAHULAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 2885 SANFORD AVE SW SUITE NO. 18083
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City | GRANDVILLE
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State | MI
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Zip | 49418-1342
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Country | US
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Telephone | 810-982-7243
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Fax |
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Provider Business Mailing Address
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Address Line | 2885 SANFORD AVE SW SUITE NO. 18083
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City | GRANDVILLE
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State | MI
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Zip | 49418-1342
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Country | US
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Telephone | 810-982-7243
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 4301078860
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 4301078860
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301078860
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License Number State | MI
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