Healthcare Provider Details

I. General information

NPI: 1124087416
Provider Name (Legal Business Name): CHANDRAKANT H PUJARA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 VENOY RD SUITE 200
WAYNE MI
48184-1869
US

IV. Provider business mailing address

5298 POND BLUFF DR
WEST BLOOMFIELD MI
48323-2442
US

V. Phone/Fax

Practice location:
  • Phone: 734-729-6710
  • Fax: 734-729-6715
Mailing address:
  • Phone: 734-459-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberCP036190
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: