Provider Demographics
NPI:1164433256
Name:GULATI, MANJIT SINGH (MD)
Entity Type:Individual
Prefix:
First Name:MANJIT
Middle Name:SINGH
Last Name:GULATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10726 CHARLESTON PL
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4906
Mailing Address - Country:US
Mailing Address - Phone:954-438-6080
Mailing Address - Fax:954-499-5599
Practice Address - Street 1:3105 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33024-2234
Practice Address - Country:US
Practice Address - Phone:954-438-6080
Practice Address - Fax:954-499-5599
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 75667207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254728700Medicaid
G24783Medicare UPIN
FL43716XMedicare Oscar/Certification