Provider Demographics
NPI:1689686446
Name:TOLIA PEDIATRIC GI CENTER PC
Entity Type:Organization
Organization Name:TOLIA PEDIATRIC GI CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VASU
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-865-0030
Mailing Address - Street 1:30055 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3230
Mailing Address - Country:US
Mailing Address - Phone:248-865-0030
Mailing Address - Fax:248-865-0034
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 240
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-865-0030
Practice Address - Fax:248-865-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty