Organization
V GOBURDHUN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIJAY GOBURDHUN M.D. (DOCTOR)
(734) 462-4000
Entity
Organization
Contact information
Practice address
14555 LEVAN RD, 403, LIVONIA, MI 48154-5083
(734) 462-4000
(734) 462-5997
Mailing address
14555 LEVAN RD, 403, LIVONIA, MI 48154-5083
(734) 462-4000
(734) 462-5997
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
VG031529
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0608215311
BLUE CROSS BLUE SHIELD OF MI
MI
05
—
1057661
—
MI
Enumeration date
06/10/2008
Last updated
07/29/2008
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