Provider Demographics
NPI:1861483646
Name:KUDESIA, VIJAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:S
Last Name:KUDESIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:27177 LAHSER RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-4714
Mailing Address - Country:US
Mailing Address - Phone:248-357-2722
Mailing Address - Fax:248-357-1745
Practice Address - Street 1:27177 LAHSER RD
Practice Address - Street 2:STE 103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4714
Practice Address - Country:US
Practice Address - Phone:248-357-2722
Practice Address - Fax:248-357-1745
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301049969207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B47880Medicare UPIN
OF361612061Medicare ID - Type Unspecified