Basic Information
| Provider Information | |||||||||
| NPI: | 1427089200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHETARPAL | ||||||||
| FirstName: | VIPIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 S. WASHINGTON AVE. | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48601 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 9897543000 | ||||||||
| FaxNumber: | 9897551365 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 S WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486012556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897543000 | ||||||||
| FaxNumber: | 9897551365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301062327 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | 4301062327 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 4301062327 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 381908328 | 01 | PPOM | OTHER | 700G361110 | 01 | BLUE CARE NETWORK MI | OTHER | 1003216 | 01 | MCLAREN HEALTHPLAN | OTHER | 110192800 | 01 | RR MEDICARE | OTHER | 381908328112 | 01 | CCM OF MICHIGAN | OTHER | 4122001 | 01 | MOLINA HEALTH CARE MI | OTHER | 123064 | 01 | GREAT LAKES HEALTH PLAN | OTHER | 381908328 | 01 | TRICARE | OTHER | TYPE 77 | 05 | MI | MEDICAID | 09885594 | 01 | HEALTHPLUS OF MICHIGAN | OTHER | 1003216 | 01 | HEALTH ADVANTAGE | OTHER | 381908328 | 01 | ONE HEALTH PLAN | OTHER | 381908328 | 01 | HCAP | OTHER | 381908328 | 01 | FIRST HEALTH | OTHER | 700G361110 | 01 | BCBS OF MICHIGAN | OTHER | 7151013 | 01 | AETNA UNDER ID 381908328 | OTHER |