Healthcare Provider Details

I. General information

NPI: 1306226238
Provider Name (Legal Business Name): MANINDERPAL SINGH DHILLON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 FEE RD ROOM A233
EAST LANSING MI
48824-6410
US

IV. Provider business mailing address

965 FEE RD ROOM A233
EAST LANSING MI
48824-6410
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-3070
  • Fax: 517-432-3603
Mailing address:
  • Phone: 517-353-3070
  • Fax: 517-432-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101021663
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5315069922
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: