Healthcare Provider Details

I. General information

NPI: 1164097721
Provider Name (Legal Business Name): NISHA JAMBULINGAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 S TELEGRAPH RD STE 220
BLOOMFIELD HILLS MI
48302-0183
US

IV. Provider business mailing address

6929 CATHEDRAL DR
BLOOMFIELD MI
48301-3727
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0784
  • Fax: 248-671-0922
Mailing address:
  • Phone: 248-508-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101028877
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: