Healthcare Provider Details

I. General information

NPI: 1649560798
Provider Name (Legal Business Name): PUNEET KUMAR AGGARWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 TELEGRAPH RD
TAYLOR MI
48180-3375
US

IV. Provider business mailing address

10501 TELEGRAPH RD
TAYLOR MI
48180-3375
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-7200
  • Fax: 313-295-0009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301106203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: