Provider Demographics
NPI:1962609297
Name:TRIVEDI, KIRTIKUMAR M (HT)
Entity type:Individual
Prefix:MR
First Name:KIRTIKUMAR
Middle Name:M
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18083 HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2611
Mailing Address - Country:US
Mailing Address - Phone:313-521-8707
Mailing Address - Fax:313-521-8707
Practice Address - Street 1:4646 JOHN R
Practice Address - Street 2:VAMC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILHT 12573246QH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology