Basic Information
| Provider Information | |||||||||
| NPI: | 1942948344 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JAGANDEEP SINGH | ||||||||
| FirstName: | UNKNOWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47198 EASTBOURNE RD | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481883023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4039714123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6700 W OUTER DR | ||||||||
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| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482352724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138361700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2022 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501018822 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.