Provider Demographics
NPI:1275595167
Name:KAMBLE, VINAY MADHUKAR (DO)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:MADHUKAR
Last Name:KAMBLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:7800 SHOAL CREEK BLVD
Practice Address - Street 2:SUITE 120W
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1098
Practice Address - Country:US
Practice Address - Phone:512-407-8880
Practice Address - Fax:512-407-8681
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1813207R00000X, 207Q00000X, 207QG0300X
MI5101014427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4472251Medicaid
MI4472251Medicaid