Provider Demographics
NPI:1386091429
Name:GUNASEKARAN, VIGNESH (MD)
Entity type:Individual
Prefix:MR
First Name:VIGNESH
Middle Name:
Last Name:GUNASEKARAN
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 1:3901 BEAUBIEN STREET, PEDIATRIC EDUCATION DEPARTMENT
Mailing Address - Street 2:CHILDREN'S HOSPITAL OF MICHIGAN
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5437
Mailing Address - Fax:313-993-7118
Practice Address - Street 1:300 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1631
Practice Address - Country:US
Practice Address - Phone:304-728-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2022-09-28
Deactivation Date:2017-01-10
Deactivation Code:
Reactivation Date:2017-02-24
Provider Licenses
StateLicense IDTaxonomies
MI4301110392390200000X
390200000X
WV308952080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program