Provider Demographics
NPI:1033370648
Name:MEDFIX P.C.
Entity Type:Organization
Organization Name:MEDFIX P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELLAM VEDAMUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-545-3297
Mailing Address - Street 1:25020 HADLOCK DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2553
Mailing Address - Country:US
Mailing Address - Phone:877-545-3297
Mailing Address - Fax:
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:SUITE B-230
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061862261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care