Healthcare Provider Details

I. General information

NPI: 1962736785
Provider Name (Legal Business Name): HANISH K SINGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 SERVICE ROAD SUITE A 225 MICHIGAN STATE UNIVERSITY CLINICAL CENTER
EAST LANSING MI
48824
US

IV. Provider business mailing address

46325 W 12 MILE RD STE 335
NOVI MI
48377-2464
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-4941
  • Fax:
Mailing address:
  • Phone: 248-697-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301097213
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301097213
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: