Provider Demographics
NPI:1982619649
Name:VAID, MUSTAK Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSTAK
Middle Name:Y
Last Name:VAID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2647 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5502
Mailing Address - Country:US
Mailing Address - Phone:248-229-7065
Mailing Address - Fax:718-934-7500
Practice Address - Street 1:19060 PARKWOOD LN
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-6804
Practice Address - Country:US
Practice Address - Phone:248-229-7065
Practice Address - Fax:718-934-7500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301085038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
M12080039Medicare ID - Type Unspecified
MIH56937Medicare UPIN
P30030001Medicare ID - Type Unspecified