Basic Information
| Provider Information | |||||||||
| NPI: | 1891289765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KADAKIA | ||||||||
| FirstName: | TANVI | ||||||||
| MiddleName: | RAJESH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6252 S ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | SUMMIT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084969549 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22201 MOROSS RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482362152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138868787 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2018 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 5901002739 | MI | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.