MEDICARE: GURJIT AJIMAL M.D.

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
1	207L00000X	Anesthesiology Physician	4301050246	MI

General Provider Information

NPI Number	:	1811952922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GURJIT AJIMAL M.D.

Provider Business Mailing Address
First Line	:	6059 BROOKSTONE LN
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-9432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30200 TELEGRAPH RD
Second Line	:	SUITE 220
City	:	BINGHAM FARMS
State	:	MI
Zip	:	48025-4502
Country	:	US
Telephone Number	:	248-258-5058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	11/07/2007

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