MEDICARE: KARANBIR SINGH MANGAT

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	183500000X	Pharmacist	5302031044	MI

General Provider Information

NPI Number	:	1174154876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARANBIR SINGH MANGAT

Provider Business Mailing Address
First Line	:	36868 TURTLE CREEK CT
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1230
Country	:	US
Telephone Number	:	248-464-4716
Fax Number	:

Provider Business Practice Location Address
First Line	:	36868 TURTLE CREEK CT
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1230
Country	:	US
Telephone Number	:	248-464-4716
Fax Number	:

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

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	01/31/2020

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