Healthcare Provider Details

I. General information

NPI: 1700083961
Provider Name (Legal Business Name): KANUREET KAUR SANDHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD CFP-421
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD CFP-421
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-8144
  • Fax: 313-916-4460
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-116596
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301095297
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: