Provider Demographics
NPI:1760884449
Name:VIBHA
Entity Type:Organization
Organization Name:VIBHA
Other - Org Name:VIJAY NARAPARAJU SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-659-2233
Mailing Address - Street 1:1375 FLUSHING RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2262
Mailing Address - Country:US
Mailing Address - Phone:810-659-2233
Mailing Address - Fax:810-659-2246
Practice Address - Street 1:1375 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2262
Practice Address - Country:US
Practice Address - Phone:810-659-2233
Practice Address - Fax:810-659-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081972207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5212865Medicaid
MI5212865Medicaid