Provider Demographics
NPI:1427089200
Name:KHETARPAL, VIPIN (MD)
Entity type:Individual
Prefix:
First Name:VIPIN
Middle Name:
Last Name:KHETARPAL
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 1:1015 S. WASHINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601
Mailing Address - Country:UM
Mailing Address - Phone:989-754-3000
Mailing Address - Fax:989-755-1365
Practice Address - Street 1:1015 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2556
Practice Address - Country:US
Practice Address - Phone:989-754-3000
Practice Address - Fax:989-755-1365
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062327207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
381908328OtherPPOM
700G361110OtherBLUE CARE NETWORK MI
1003216OtherMCLAREN HEALTHPLAN
110192800OtherRR MEDICARE
381908328112OtherCCM OF MICHIGAN
4122001OtherMOLINA HEALTH CARE MI
123064OtherGREAT LAKES HEALTH PLAN
381908328OtherTRICARE
MITYPE 77Medicaid
09885594OtherHEALTHPLUS OF MICHIGAN
1003216OtherHEALTH ADVANTAGE
381908328OtherONE HEALTH PLAN
381908328OtherHCAP
381908328OtherFIRST HEALTH
700G361110OtherBCBS OF MICHIGAN
7151013OtherAETNA UNDER ID 381908328
381908328OtherONE HEALTH PLAN
381908328OtherTRICARE