Provider Demographics
NPI:1093762791
Name:CADNAPAPHORNCHAI, PRAVIT (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVIT
Middle Name:
Last Name:CADNAPAPHORNCHAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE ROAD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-745-0011
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:HARPER PROFESSIONAL BLDG STE 917
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2017
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-0011
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301034170207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630026Medicare PIN