Healthcare Provider Details

I. General information

NPI: 1306756598
Provider Name (Legal Business Name): ACTIVE MEDICAL INFUSIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 VENOY RD STE 800
WAYNE MI
48184-2495
US

IV. Provider business mailing address

4020 VENOY RD STE 800
WAYNE MI
48184-2495
US

V. Phone/Fax

Practice location:
  • Phone: 734-707-4630
  • Fax: 844-707-4630
Mailing address:
  • Phone: 734-707-4630
  • Fax: 844-707-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HARPINDER BHANGOO
Title or Position: ADMINISTRATOR
Credential:
Phone: 734-707-4630