Organization
TOLIA PEDIATRIC GI CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VASUNDHARA TOLIA MD (OWNER/PHYSICIAN)
(248) 865-0030
Entity
Organization
Contact information
Practice address
22250 PROVIDENCE DR, SUITE 400, SOUTHFIELD, MI 48075-4825
(248) 865-0030
(248) 865-0034
Mailing address
22250 PROVIDENCE DR, SUITE 400, SOUTHFIELD, MI 48075-4825
(248) 865-0030
(248) 865-0034
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
4301037974
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3506356221
BCBS BCN
MI
01
—
350F338410
BCBS BCN
MI
05
—
4909504
—
MI
Enumeration date
10/03/2006
Last updated
06/20/2008
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