Healthcare Provider Details

I. General information

NPI: 1073997847
Provider Name (Legal Business Name): JAGRAJ SINGH BRAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2015
Last Update Date: 07/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E MOUNT HOPE AVE
LANSING MI
48910-3207
US

IV. Provider business mailing address

2283 KNOB HILL DR APT 10
OKEMOS MI
48864-3568
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-3400
  • Fax:
Mailing address:
  • Phone: 905-487-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301107581
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: