Provider Demographics
NPI:1417956855
Name:NAYAK, PADMINI KEPUL (MD)
Entity Type:Individual
Prefix:
First Name:PADMINI
Middle Name:KEPUL
Last Name:NAYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KEPAL
Other - Middle Name:PADMINI
Other - Last Name:NAYAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:25925 TELEGRAPH RD
Mailing Address - Street 2:210
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2518
Mailing Address - Country:US
Mailing Address - Phone:248-746-0342
Mailing Address - Fax:248-746-0308
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3000
Practice Address - Fax:248-849-5392
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034883207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79178Medicare UPIN