Healthcare Provider Details

I. General information

NPI: 1760536528
Provider Name (Legal Business Name): AVTAR S SEKHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19020 FORT ST
RIVERVIEW MI
48193-6701
US

IV. Provider business mailing address

8090 LILLIAN CT
CANTON MI
48187-1476
US

V. Phone/Fax

Practice location:
  • Phone: 734-362-5100
  • Fax: 734-362-5147
Mailing address:
  • Phone: 734-335-7205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00047478
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: