Basic Information
| Provider Information | |||||||||
| NPI: | 1386264919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZALAVADIYA | ||||||||
| FirstName: | NIRAV | ||||||||
| MiddleName: | BIPINKUMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 RIVERFRONT DR APT 9F | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482264598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8573139875 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6071 W. OUTER DRIVE | ||||||||
| Address2: | DEPARTMENT OF MEDICINE - 4 MAIN | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139663300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2020 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.