Provider Demographics
NPI:1003011131
Name:DOSHI, VISHAL (PT)
Entity Type:Individual
Prefix:MR
First Name:VISHAL
Middle Name:
Last Name:DOSHI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 HERONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0836
Mailing Address - Country:US
Mailing Address - Phone:866-377-4545
Mailing Address - Fax:
Practice Address - Street 1:2414 HERONWOOD DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0836
Practice Address - Country:US
Practice Address - Phone:866-377-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35868OtherBLUE CROSS BLUE SHIELD
MI0N44700001Medicare ID - Type UnspecifiedPHYSICAL THERAPIST