Provider Demographics
NPI:1700823291
Name:MOUDGAL, VARSHA VIVEK (MD)
Entity Type:Individual
Prefix:
First Name:VARSHA
Middle Name:VIVEK
Last Name:MOUDGAL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:STE 6109
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-0000
Practice Address - Country:US
Practice Address - Phone:734-712-8600
Practice Address - Fax:734-712-8636
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-09-26
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Provider Licenses
StateLicense IDTaxonomies
MIVM071985207RI0200X
MI4301071985207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4895454-10Medicaid
MI4895454-10Medicaid