Healthcare Provider Details

I. General information

NPI: 1891428413
Provider Name (Legal Business Name): DEEWAN G BULCHANDANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 SOUTHLAND DR
MOBILE AL
36693-3313
US

IV. Provider business mailing address

13600 RESERVOIR DR
MOSS POINT MS
39562-8749
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-0153
  • Fax: 251-662-8050
Mailing address:
  • Phone: 601-919-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number53853
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: