Provider Demographics
NPI:1669474409
Name:NAGAPPAN, VIJAYALKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYALKSHMI
Middle Name:
Last Name:NAGAPPAN
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 1:43800 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1136
Mailing Address - Country:US
Mailing Address - Phone:800-848-0202
Mailing Address - Fax:586-226-6949
Practice Address - Street 1:4900 MERCURY DR
Practice Address - Street 2:STE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2947
Practice Address - Country:US
Practice Address - Phone:313-982-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076671207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI475453610Medicaid
05741830OtherECFMG