Provider Demographics
NPI:1679736565
Name:TRIVEDI, KOMAL A (MD)
Entity Type:Individual
Prefix:DR
First Name:KOMAL
Middle Name:A
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 505
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-465-4163
Mailing Address - Fax:248-662-4411
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 505
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-465-4163
Practice Address - Fax:248-662-4411
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2015-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301089840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine