Healthcare Provider Details

I. General information

NPI: 1770936601
Provider Name (Legal Business Name): SONAL TALWAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

IV. Provider business mailing address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

V. Phone/Fax

Practice location:
  • Phone: 586-498-4422
  • Fax: 586-498-4440
Mailing address:
  • Phone: 586-498-4422
  • Fax: 586-498-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301110904
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: