Provider Demographics
NPI:1770548232
Name:DANESHVAR, HUDSON H (MD)
Entity type:Individual
Prefix:DR
First Name:HUDSON
Middle Name:H
Last Name:DANESHVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32950 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-6802
Mailing Address - Country:US
Mailing Address - Phone:734-422-2020
Mailing Address - Fax:734-422-4040
Practice Address - Street 1:32950 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-6802
Practice Address - Country:US
Practice Address - Phone:734-422-2020
Practice Address - Fax:734-422-4040
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106349751OtherBCBS
MI134289255OtherCOMMERCIAL/TAX ID
MI141151OtherCARE CHOICE/PREF CH
MI4788169Medicaid
MI0P18230Medicare ID - Type Unspecified
MI4788169Medicaid