Provider Demographics
NPI:1386641397
Name:TRIVEDI, CHARU L (MD)
Entity Type:Individual
Prefix:
First Name:CHARU
Middle Name:L
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:734-242-7902
Mailing Address - Fax:
Practice Address - Street 1:800 STEWART RD
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4226
Practice Address - Country:US
Practice Address - Phone:734-242-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078923T207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
900003594OtherRAILROAD MEDICARE
OH2224239Medicaid
OHTR4038771Medicare PIN
900003594OtherRAILROAD MEDICARE
H27054Medicare UPIN