Healthcare Provider Details

I. General information

NPI: 1164433256
Provider Name (Legal Business Name): MANJIT SINGH GULATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 N UNIVERSITY DR
DAVIE FL
33024-2234
US

IV. Provider business mailing address

10726 CHARLESTON PL
HOLLYWOOD FL
33026-4906
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-6080
  • Fax: 954-499-5599
Mailing address:
  • Phone: 954-438-6080
  • Fax: 954-499-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME 75667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: