Provider Demographics
NPI:1649272477
Name:DANI, NIKETA (MD)
Entity type:Individual
Prefix:
First Name:NIKETA
Middle Name:
Last Name:DANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 SOMERSET BLVD
Mailing Address - Street 2:201
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4221
Mailing Address - Country:US
Mailing Address - Phone:248-822-8021
Mailing Address - Fax:
Practice Address - Street 1:102 N ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2670
Practice Address - Country:US
Practice Address - Phone:810-629-2245
Practice Address - Fax:810-629-6535
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102512701OtherBCBS ID
MI4917570Medicaid
MI0997573OtherHEALTHPLUS ID
MIC7533OtherMCARE ID
MI381746096OtherTAX ID
MI4301068226OtherCONTROLLED SUBSTANCE
MI1020492OtherMCLAREN HEALTH PLAN ID