Provider Demographics
NPI:1235183740
Name:GOSSAIN, VED V (MD)
Entity Type:Individual
Prefix:DR
First Name:VED
Middle Name:V
Last Name:GOSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD, A201
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4650 S HAGADORN RD # A100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5396
Practice Address - Country:US
Practice Address - Phone:517-353-4830
Practice Address - Fax:517-355-2134
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034981207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1202501Medicaid
MID72572Medicare UPIN
MI0C36082071Medicare PIN