1386091429 NPI number — MR. VIGNESH GUNASEKARAN M.D

Table of content: MR. VIGNESH GUNASEKARAN M.D (NPI 1386091429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386091429 NPI number — MR. VIGNESH GUNASEKARAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNASEKARAN
Provider First Name:
VIGNESH
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1386091429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/10/2017
NPI Reactivation Date:
02/24/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 BEAUBIEN STREET, PEDIATRIC EDUCATION DEPARTMENT
Provider Second Line Business Mailing Address:
CHILDREN'S HOSPITAL OF MICHIGAN
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:
313-745-5437
Provider Business Mailing Address Fax Number:
313-993-7118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S PRESTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25438-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-728-1795
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2016

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:  4301110392 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: 30895 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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