Provider Demographics
NPI:1275706434
Name:PANKAJ VAKHARIA MD PLLC
Entity Type:Organization
Organization Name:PANKAJ VAKHARIA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:N
Authorized Official - Last Name:VAKHARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-328-4000
Mailing Address - Street 1:3547 INVERNESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4757
Mailing Address - Country:US
Mailing Address - Phone:248-328-4000
Mailing Address - Fax:248-328-1304
Practice Address - Street 1:15224 APOLLO DRIVE
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1166
Practice Address - Country:US
Practice Address - Phone:248-328-4000
Practice Address - Fax:248-328-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPV033669261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110203900OtherR.R. MEDICARE
MI4217778OtherMEDICAID, FLINT
MIPV033669OtherLICENSE
MI1106338622OtherBCBSM
MI4217820Medicaid
MI1144302OtherHEALTHPLUS
MI1106338622OtherBCBSM
MI4217778OtherMEDICAID, FLINT