Provider Demographics
NPI:1952694531
Name:VAKHARIA, NATHAN P (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:P
Last Name:VAKHARIA
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 1:824 A PETERSON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-9246
Mailing Address - Country:US
Mailing Address - Phone:608-843-6460
Mailing Address - Fax:
Practice Address - Street 1:824 A PETERSON MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-9246
Practice Address - Country:US
Practice Address - Phone:608-843-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105329207Q00000X
WI59487390200000X
WI59487-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program