Provider Demographics
NPI:1124085014
Name:AMIN, VIJAYKUMAR C (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYKUMAR
Middle Name:C
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 SIDERWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6026
Mailing Address - Country:US
Mailing Address - Phone:321-636-0028
Mailing Address - Fax:321-636-0028
Practice Address - Street 1:3322 SIDERWHEEL DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6026
Practice Address - Country:US
Practice Address - Phone:321-636-0028
Practice Address - Fax:321-636-0028
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029193A207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND69736Medicare UPIN