Healthcare Provider Details

I. General information

NPI: 1548207467
Provider Name (Legal Business Name): KULDIP S. DEOGUN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43145 SCHOENHERR RD UNIT #13
STERLING HEIGHTS MI
48313-1955
US

IV. Provider business mailing address

PO BOX 33747 DEPT 999437
DETROIT MI
48232-3747
US

V. Phone/Fax

Practice location:
  • Phone: 586-997-5048
  • Fax: 586-997-5049
Mailing address:
  • Phone: 248-543-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KULDIP S. DEOGUN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 586-997-5048