MEDICARE: BARUN AGARWALLA MBBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1104761030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARUN AGARWALLA MBBS

Provider Business Mailing Address
First Line	:	JOBRA ROAD COLLEGE SQUARE
Second Line	:	MAL90DOWN POLICE STATION
City	:	CUTTACK
State	:	ODISHA
Zip	:	753003
Country	:	IN
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	DETROIT MEDICAL CENTER
Second Line	:	4201 ST. ANTOINE STREET, SUITE 9C
City	:	DETROIT
State	:	MI
Zip	:	48201
Country	:	US
Telephone Number	:	313-745-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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