Healthcare Provider Details

I. General information

NPI: 1629767900
Provider Name (Legal Business Name): MAHA JANGDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18600 VAN HORN RD STE A
WOODHAVEN MI
48183-3853
US

IV. Provider business mailing address

18600 VAN HORN RD STE A
WOODHAVEN MI
48183-3853
US

V. Phone/Fax

Practice location:
  • Phone: 734-766-4446
  • Fax: 734-982-3003
Mailing address:
  • Phone: 734-766-4446
  • Fax: 734-982-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301518130
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: