Provider Demographics
NPI:1184204612
Name:BATHLA, JASDEEP SINGH
Entity Type:Individual
Prefix:
First Name:JASDEEP
Middle Name:SINGH
Last Name:BATHLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 MEADOW REED DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2743
Mailing Address - Country:US
Mailing Address - Phone:586-215-6454
Mailing Address - Fax:
Practice Address - Street 1:4201 ST ANTOINE
Practice Address - Street 2:UHC-9C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program