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General NPI Number Information
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NPI Number | 1962630806
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Entity Type | Individual
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Provider Name | TINA PAUL PATHADAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 27970 ORCHARD LAKE RD SUITE 4
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3767
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Country | US
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Telephone | 248-737-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 17187 SCHAEFER HWY SUITE 4
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City | DETROIT
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State | MI
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Zip | 48235-4132
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Country | US
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Telephone | 313-367-2767
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Fax | 313-367-2818
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101018954
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License Number State | MI
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