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General NPI Number Information
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NPI Number | 1184892911
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Entity Type | Organization
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Legal Business Name | B S PANNU MD PC
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7349 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48214-2308
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Country | US
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Telephone | 313-822-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 14040 NADINE ST
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City | OAK PARK
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State | MI
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Zip | 48237-1126
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Country | US
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Telephone | 646-352-2761
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BALJINDER S PANNU
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Credential | M.D.
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Telephone | 646-352-2761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | MI
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