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General NPI Number Information
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NPI Number | 1932423332
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Entity Type | Organization
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Legal Business Name | PUNITHA VIJAYAKUMAR MD PC
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 25400 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-6200
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Country | US
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Telephone | 313-292-9233
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Fax | 313-292-9023
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Provider Business Mailing Address
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Address Line | 25400 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-6200
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Country | US
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Telephone | 313-292-9233
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Fax | 313-292-9023
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PUNITHA VIJAYAKUMAR
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Credential | M.D.
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Telephone | 313-292-9233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301072977
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License Number State | MI
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