Individual
PADMA PADIVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15150 FORT ST, SOUTHGATE, MI 48195-1302
(734) 282-4800
Mailing address
45948 WINDRIDGE LN, CANTON, MI 48188-6223
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
AG03220068
MI
Other
Enumeration date
04/18/2022
Last updated
10/01/2024
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