Provider Demographics
NPI:1467428946
Name:DUA, VEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:
Last Name:DUA
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 1:8542 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1310
Mailing Address - Country:US
Mailing Address - Phone:734-455-8310
Mailing Address - Fax:734-455-8318
Practice Address - Street 1:8542 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1310
Practice Address - Country:US
Practice Address - Phone:734-455-8310
Practice Address - Fax:734-455-8318
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032407208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1974302Medicaid
MI1981272Medicaid
MI1981272Medicaid
MI1974302Medicaid