Healthcare Provider Details

I. General information

NPI: 1891790663
Provider Name (Legal Business Name): JEET N PILLAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N POND DR STE C
WALLED LAKE MI
48390-3079
US

IV. Provider business mailing address

100 N POND DR STE C
WALLED LAKE MI
48390-3079
US

V. Phone/Fax

Practice location:
  • Phone: 248-624-2222
  • Fax: 248-926-9455
Mailing address:
  • Phone: 248-624-2222
  • Fax: 248-926-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4310083902
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: