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NPI Code Detail

MEDICARE: MR. SUBBIAH GANDHI-SUBRAMANIAN P.T.

MEDICARE: MR. SUBBIAH GANDHI-SUBRAMANIAN P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5501006702MI

General Provider Information

NPI Number : 1205158334
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SUBBIAH GANDHI-SUBRAMANIAN P.T.
Provider Business Mailing Address
First Line : 4745 MICHIGAN AVE
Second Line :
City : DETROIT
State : MI
Zip : 48210-3247
Country : US
Telephone Number : 313-899-3703
Fax Number : 313-899-3713
Provider Business Practice Location Address
First Line : 4745 MICHIGAN AVE
Second Line :
City : DETROIT
State : MI
Zip : 48210-3247
Country : US
Telephone Number : 313-899-3703
Fax Number : 313-899-3713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2010
Last Update Date : 02/16/2010

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