Provider Demographics
NPI:1316688815
Name:CHAUDHURY, TRISHA (DO)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:CHAUDHURY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11885 E 12 MILE RD STE 202A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3469
Mailing Address - Country:US
Mailing Address - Phone:586-582-7090
Mailing Address - Fax:586-582-7091
Practice Address - Street 1:11885 E 12 MILE RD STE 202A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3469
Practice Address - Country:US
Practice Address - Phone:586-582-7090
Practice Address - Fax:586-582-7091
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program