Individual
DR. NITIN GANGADHAR VAISHAMPAYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4100 JOHN R ST, GERSHENSON RADIATION ONCOLOGY CTR, DETROIT, MI 48201-2013
(800) 527-6266
(313) 576-9640
Mailing address
1560 E MAPLE RD, SUITE 400-CREDENTIALING, TROY, MI 48083-1189
(248) 581-5974
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
4301057935
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104174
GREAT LAKES HEALTH PLAN (X-RAY)
MI
01
—
104179
GREAT LAKES HEALTH PLAN (AOAM)
MI
01
—
111209
CARE CHOICES HMO PROV. #
MI
05
—
4204199
—
MI
05
—
4254010
—
MI
Enumeration date
02/15/2006
Last updated
02/03/2016
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