Provider Demographics
NPI:1447212642
Name:PAI, DIVAKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVAKAR
Middle Name:
Last Name:PAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 BARCLAY CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5804
Mailing Address - Country:US
Mailing Address - Phone:248-844-1010
Mailing Address - Fax:248-844-9089
Practice Address - Street 1:645 BARCLAY CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5804
Practice Address - Country:US
Practice Address - Phone:248-844-1010
Practice Address - Fax:248-844-9089
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043103207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104257512Medicaid
MI700F37550OtherBCXBSM
MI700F37550OtherBCN
MIB44346OtherHAP
MIB44346OtherHAP
MIM89900002Medicare PIN