MEDICARE: DR. VASUNDHARA TOLIA MBBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0206X	Pediatric Gastroenterology Physician	37974	MI

General Provider Information

NPI Number	:	1881603975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASUNDHARA TOLIA MBBS

Provider Business Mailing Address
First Line	:	4304 COPPER CLIFF
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1922
Country	:	US
Telephone Number	:	248-647-3243
Fax Number	:	248-647-2227

Provider Business Practice Location Address
First Line	:	4304 COPPER CLIFF
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1922
Country	:	US
Telephone Number	:	248-647-3243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	09/05/2012

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