Provider Demographics
NPI:1740570811
Name:VINAYA K. GAVINI MDPC
Entity Type:Organization
Organization Name:VINAYA K. GAVINI MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINAYA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GAVINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-595-8304
Mailing Address - Street 1:8550 N SILVERY LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4510
Mailing Address - Country:US
Mailing Address - Phone:313-730-7007
Mailing Address - Fax:313-730-7002
Practice Address - Street 1:8550 N SILVERY LN
Practice Address - Street 2:SUITE 101
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4510
Practice Address - Country:US
Practice Address - Phone:313-730-7007
Practice Address - Fax:313-730-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2990848Medicaid
MI2990848Medicaid