Basic Information
| Provider Information | |||||||||
| NPI: | 1154828036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEDAR | ||||||||
| FirstName: | ROHAN | ||||||||
| MiddleName: | PRAVEEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5958 N CANTON CENTER RD STE 900 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481872740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347371200 | ||||||||
| FaxNumber: | 7347371205 | ||||||||
| Practice Location | |||||||||
| Address1: | 5958 N CANTON CENTER RD STE 900 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481872740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347862300 | ||||||||
| FaxNumber: | 7347864915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2018 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 4301503381 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.