1568747079 NPI number — MR. SMITKUMAR KADAKIA

Table of content: MR. SMITKUMAR KADAKIA (NPI 1568747079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568747079 NPI number — MR. SMITKUMAR KADAKIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KADAKIA
Provider First Name:
SMITKUMAR
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1568747079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22950 VAN DYKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48089-2346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-759-1391
Provider Business Mailing Address Fax Number:
586-759-4347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13901 METROPOLITAN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48312-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-446-8770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2011

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: 183500000X , with the licence number:  5302036220 , 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)