Great Lakes Physicians of Redford,P.L.L.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1630863 Issued in MI

Legal business name

GREAT LAKES PHYSICIANS OF REDFORD,P.L.L.C.

Practice address

25321 5 Mile Rd
Suite # 1
Redford, MI 48239-3700

Phone

(313) 538-1800

Fax

(313) 538-9082

NPI assigned

Mar 9, 2008

Last updated

Mar 9, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mustak Y Vaid, M.D.

Title

Solo Owner

Phone

(248) 996-8777

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205020800000",
    "number": "1063682730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23300 PROVIDENCE DR",
            "address_2": "SUITE # 104",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753652",
            "telephone_number": "248-996-8777",
            "fax_number": "248-996-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25321 5 MILE RD",
            "address_2": "SUITE # 1",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482393700",
            "telephone_number": "313-538-1800",
            "fax_number": "313-538-9082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICIANS OF REDFORD,P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-09",
        "last_updated": "2008-03-09",
        "status": "A",
        "authorized_official_last_name": "VAID",
        "authorized_official_first_name": "MUSTAK",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "SOLO OWNER",
        "authorized_official_telephone_number": "248-996-8777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "1630863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Redford, MI
• Providers in Redford, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.