1073169132 NPI number — DR. ARJUN TRIVEDI M.D., M.S.

Table of content: DR. ARJUN TRIVEDI M.D., M.S. (NPI 1073169132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073169132 NPI number — DR. ARJUN TRIVEDI M.D., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIVEDI
Provider First Name:
ARJUN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073169132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DIVISION OF ENDOCRINOLOGY, WAYNE STATE UNIVERSITY/DMC
Provider Second Line Business Mailing Address:
UNIVERSITY HEALTH CENTER 4201 ST. ANTOINE ST, SUITE 4H
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-745-4008
Provider Business Mailing Address Fax Number:
313-745-5565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22250 PROVIDENCE DRIVE, ACADEMIC INTERNAL MEDICINE
Provider Second Line Business Practice Location Address:
SUITE #301
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-849-3281
Provider Business Practice Location Address Fax Number:
248-849-5449
Provider Enumeration Date:
08/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  4351045188 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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