Individual
KISMATKUMAR DETROJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 SILVER STREET, MIDDLETOWN, CT 06457
(860) 951-4954
Mailing address
170 TALCOTT RIDGE RD, SOUTH WINDSOR, CT 06074-2386
(860) 794-9160
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
044462
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001444629
—
CT
01
—
010044462CT01
BCBS
CT
01
—
144462
CONNECTICARE
CT
01
—
149777465
CIGNA
—
01
—
1497774657
CHN
CT
01
—
207787971
TRICARE
—
01
—
41044914
TRICARE
—
01
—
581828
HMN
CT
01
—
7382858
AETNA
CT
01
—
7382858
AETNA
—
Enumeration date
07/19/2006
Last updated
12/21/2023
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