Provider Demographics
NPI:1134133937
Name:VIDINAS, MARIUS G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIUS
Middle Name:G
Last Name:VIDINAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12745 S SAGINAW ST
Mailing Address - Street 2:#806-196
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2437
Mailing Address - Country:US
Mailing Address - Phone:248-691-8646
Mailing Address - Fax:
Practice Address - Street 1:44201 DEQUINDRE RD
Practice Address - Street 2:SUITE C
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-691-8646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079836208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00311215OtherRAILROAD MEDICARE INDIVIDUAL PIN
MI1102512141OtherBLUE CROSS & BLUE SHIELD
MI01002481OtherHEALTHPLUS OF MICHIGAN
MICF9870OtherRAILROAD MEDICARE GROUP PIN
MI4827777Medicaid
MI0M84990004Medicare PIN
MI01002481OtherHEALTHPLUS OF MICHIGAN