Provider Demographics
NPI:1174728372
Name:KHANPARA, VIPUL DHARAMSHI (MD)
Entity type:Individual
Prefix:
First Name:VIPUL
Middle Name:DHARAMSHI
Last Name:KHANPARA
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 1:1221 PINE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3511
Mailing Address - Country:US
Mailing Address - Phone:810-989-3300
Mailing Address - Fax:810-985-2671
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-989-3300
Practice Address - Fax:810-985-2671
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301116733207P00000X
WI50209207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00414061OtherMEDICARE RAILROAD
WI34791600Medicaid
WI34791600Medicaid