Healthcare Provider Details

I. General information

NPI: 1619664984
Provider Name (Legal Business Name): KSHITIJ MAHAJAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 W 13 MILE RD
ROYAL OAK MI
48073-6767
US

IV. Provider business mailing address

3711 W 13 MILE RD
ROYAL OAK MI
48073-6767
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-6489
  • Fax:
Mailing address:
  • Phone: 248-551-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4351051793
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4351051793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: