Healthcare Provider Details

I. General information

NPI: 1962630699
Provider Name (Legal Business Name): HITESH SINGH SANDHU MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

8841 RIVER PINE DR
CORDOVA TN
38016-7101
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5629
  • Fax:
Mailing address:
  • Phone: 901-287-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4301093989
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0000049968
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: