Healthcare Provider Details

I. General information

NPI: 1134196850
Provider Name (Legal Business Name): AMIT A NANDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COMMERCE DR
BROCKWAY MI
48097-3460
US

IV. Provider business mailing address

3050 COMMERCE DR SUITE B
FORT GRATIOT MI
48059-3819
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-9612
  • Fax: 810-387-9611
Mailing address:
  • Phone: 810-385-4441
  • Fax: 810-385-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301068236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: