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General NPI Number Information
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NPI Number | 1710912605
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Entity Type | Organization
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Legal Business Name | BN NANDISH MD PC INC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 45438 IRVINE DR
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City | NOVI
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State | MI
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Zip | 48374-3772
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Country | US
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Telephone | 248-449-4032
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Fax | 248-449-4032
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | NOVI
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State | MI
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Zip | 48376-0247
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Country | US
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Telephone | 248-449-4032
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Fax | 248-449-4032
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. BANATHALLY NANJUNDASWAMY NANDISH
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Credential | MD
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Telephone | 248-449-4032
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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 | 4301079475
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License Number State | MI
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