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General NPI Number Information
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NPI Number | 1104247899
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Entity Type | Organization
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Legal Business Name | WOODWARD GASTROENTEROLOGY PC
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 1695 12 MILE RD SUITE 220
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City | BERKLEY
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State | MI
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Zip | 48072-2182
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Country | US
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Telephone | 248-229-8354
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Fax |
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Provider Business Mailing Address
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Address Line | 1257 CLUB DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0907
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Country | US
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Telephone | 248-229-8354
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TUSAR KISHORE DESAI
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Credential | MD
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Telephone | 248-229-8354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301044285
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License Number State | MI
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