Healthcare Provider Details

I. General information

NPI: 1699866509
Provider Name (Legal Business Name): RAJESH CHANDER GULATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAJESH C GULATI MD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N HAGGERTY RD STE B2
CANTON MI
48187-3795
US

IV. Provider business mailing address

2050 N HAGGERTY RD STE B2
CANTON MI
48187-3795
US

V. Phone/Fax

Practice location:
  • Phone: 734-326-0740
  • Fax: 734-326-0785
Mailing address:
  • Phone: 734-326-0740
  • Fax: 734-326-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301035830
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: