Healthcare Provider Details

I. General information

NPI: 1477867273
Provider Name (Legal Business Name): JASPAUL SINGH DULKU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44250 DEQUINDRE RD
STERLING HEIGHTS MI
48314-1002
US

IV. Provider business mailing address

44250 DEQUINDRE RD
STERLING HEIGHTS MI
48314-1002
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-0430
  • Fax: 248-964-1830
Mailing address:
  • Phone: 248-964-0430
  • Fax: 248-964-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301097247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: