Healthcare Provider Details

I. General information

NPI: 1073760088
Provider Name (Legal Business Name): SANJOY MUKERJEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25650 OUTER DR
LINCOLN PARK MI
48146-2096
US

IV. Provider business mailing address

2700 HAMLIN BLVD
INKSTER MI
48141-2206
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-5100
  • Fax: 313-565-0309
Mailing address:
  • Phone: 313-561-5100
  • Fax: 313-565-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301090277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: