Provider Demographics
NPI:1215178207
Name:VANDORDAKLOU, NEGEAN (MD)
Entity type:Individual
Prefix:
First Name:NEGEAN
Middle Name:
Last Name:VANDORDAKLOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 PARKVIEW LN
Mailing Address - Street 2:APT 203
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3409
Mailing Address - Country:US
Mailing Address - Phone:310-658-3213
Mailing Address - Fax:
Practice Address - Street 1:13900 PARKVIEW LN
Practice Address - Street 2:APT 203
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3409
Practice Address - Country:US
Practice Address - Phone:310-658-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092691207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine