Provider Demographics
NPI:1669474409
Name:NAGAPPAN, VIJAYALKSHMI (MD)
Entity type:Individual
Prefix:
First Name:VIJAYALKSHMI
Middle Name:
Last Name:NAGAPPAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4598 APPLETREE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3910
Mailing Address - Country:US
Mailing Address - Phone:956-331-2458
Mailing Address - Fax:586-226-6949
Practice Address - Street 1:18181 OAKWOOD BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4082
Practice Address - Country:US
Practice Address - Phone:248-396-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076671207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
05741830OtherECFMG
MI475453610Medicaid