Individual
VIJAY K MITTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22250 PROVIDENCE DRIVE, SUITE 703A, SOUTHFIELD, MI 48075
(248) 849-5862
(248) 849-8117
Mailing address
22250 PROVIDENCE DRIVE, SUITE 703A, SOUTHFIELD, MI 48075
(248) 849-5862
(248) 849-8117
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
VM037030
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0208212582
BCBS
MI
05
—
2114520
—
MI
01
—
P46853
BCN
—
Enumeration date
09/01/2006
Last updated
07/08/2007
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