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General NPI Number Information
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NPI Number | 1518157478
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Entity Type | Individual
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Provider Name | GAGANDEEP SINGH RAWAL M.D
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Gender | Male
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 1 HURLEY PLZ DEP OF RADIOLOGY
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City | FLINT
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State | MI
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Zip | 48503
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Country | US
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Telephone | 810-262-9828
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Fax |
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Provider Business Mailing Address
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Address Line | 6481 MOONSTONE DR
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City | GRAND BLANC
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State | MI
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Zip | 48439-7811
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Country | US
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Telephone | 320-420-3657
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301088722
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License Number State | MI
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