Provider Demographics
NPI:1477758712
Name:WASADE, VIBHANGINI SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIBHANGINI
Middle Name:SANJAY
Last Name:WASADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIBHANGINI
Other - Middle Name:MURLIDHAR
Other - Last Name:BOBDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2694
Mailing Address - Country:US
Mailing Address - Phone:248-549-2110
Mailing Address - Fax:248-546-2157
Practice Address - Street 1:110 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2694
Practice Address - Country:US
Practice Address - Phone:248-549-2110
Practice Address - Fax:248-546-2157
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010889472084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology