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General NPI Number Information
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NPI Number | 1992390975
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Entity Type | Organization
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Legal Business Name | VK IATROS PLLC
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 47601 GRAND RIVER AVE FL LABOR3
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City | NOVI
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State | MI
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Zip | 48374-1233
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Country | US
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Telephone | 248-910-3884
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Fax |
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Provider Business Mailing Address
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Address Line | 24789 TODDY LN
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-2075
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Country | US
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Telephone | 248-910-3884
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | DR. VIJAYAKIRAN KAZA
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Credential | M.D
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Telephone | 248-910-3884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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