Provider Demographics
NPI:1538706395
Name:BAIDWAN, LAKHVIR (LARRY) (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAKHVIR (LARRY)
Middle Name:
Last Name:BAIDWAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26300 FORD RD # 117
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2854
Mailing Address - Country:US
Mailing Address - Phone:734-787-8827
Mailing Address - Fax:
Practice Address - Street 1:7350 N MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2502
Practice Address - Country:US
Practice Address - Phone:734-793-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-28
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist