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General NPI Number Information
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NPI Number | 1417039611
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Entity Type | Organization
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Legal Business Name | GRATIOT MEDICAL SPECIALISTS, P.C.
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 300 E WARWICK DR
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City | ALMA
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State | MI
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Zip | 48801-1014
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Country | US
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Telephone | 989-463-5740
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 173
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City | ALMA
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State | MI
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Zip | 48801-0173
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Country | US
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Telephone | 989-463-5740
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PANKAJ JANDWANI
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Credential | M.D.
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Telephone | 989-463-5740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301070136
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License Number State | MI
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