Basic Information
| Provider Information | |||||||||
| NPI: | 1013928332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINGH | ||||||||
| FirstName: | VIDYANAND | ||||||||
| MiddleName: | BUDHRAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BUDHRAM SINGH | ||||||||
| OtherFirstName: | VIDYANAND | ||||||||
| OtherMiddleName: | NANDRASHWAR | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 29115 RACHID LANE | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865984782 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 51086 FAIRCHILD RD | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480511998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869493064 | ||||||||
| FaxNumber: | 5869494367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 01/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301074119 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4991924 | 05 | MI | MEDICAID | 4994720 | 05 | MI | MEDICAID |