Provider Demographics
NPI:1255392403
Name:VINAIK, CHARU (PT)
Entity type:Individual
Prefix:
First Name:CHARU
Middle Name:
Last Name:VINAIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3058 METRO PKWY
Mailing Address - Street 2:STE 207
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:586-983-3980
Mailing Address - Fax:586-983-5173
Practice Address - Street 1:3058 METRO PKWY
Practice Address - Street 2:STE 207
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-983-3980
Practice Address - Fax:586-983-5173
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICV006242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4399198Medicaid
MI650E057460OtherBCBS OF MI
P37382Medicare UPIN
MI4399198Medicaid