Provider Demographics
NPI:1386773851
Name:VATS, SUBODH (MD)
Entity type:Individual
Prefix:DR
First Name:SUBODH
Middle Name:
Last Name:VATS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:461 W HURON ST
Mailing Address - Street 2:DEPARTMENT OF OB GYN
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1601
Mailing Address - Country:US
Mailing Address - Phone:248-857-7316
Mailing Address - Fax:248-857-6895
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:DEPARTMENT OF OB GYN
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-857-7316
Practice Address - Fax:248-857-6895
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044217207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA77162Medicare UPIN