Provider Demographics
NPI:1609847896
Name:SINGH, VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:SINGH
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 1:1601 ROOSEVELT RD
Mailing Address - Street 2:PO BOX 6
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1043
Mailing Address - Country:US
Mailing Address - Phone:888-724-6377
Mailing Address - Fax:715-251-1681
Practice Address - Street 1:1601 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-1043
Practice Address - Country:US
Practice Address - Phone:888-724-6377
Practice Address - Fax:715-251-1681
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34886208VP0014X
MI4301055155208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391867916010OtherBCBS
MI050049958OtherRAILROAD MEDICARE
1008929OtherPREFERRED ONE
MI050B210120OtherBCBS
WI31536700Medicaid
WI050049959OtherRAILROAD MEDICARE
WI050049959OtherRAILROAD MEDICARE
E50116Medicare UPIN
WI40015-0002Medicare PIN
MI050049958OtherRAILROAD MEDICARE
WI000112008Medicare PIN
WI000146084Medicare PIN