Provider Demographics
NPI:1275703407
Name:AGGARWAL AND ASSOCIATES, MDS, PC
Entity Type:Organization
Organization Name:AGGARWAL AND ASSOCIATES, MDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INDERJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-751-6270
Mailing Address - Street 1:29610 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4247
Mailing Address - Country:US
Mailing Address - Phone:586-751-6270
Mailing Address - Fax:586-751-7171
Practice Address - Street 1:29610 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4247
Practice Address - Country:US
Practice Address - Phone:586-751-6270
Practice Address - Fax:586-751-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032405207R00000X
MI4301034546207RC0000X
MI4301032882207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1329716Medicaid
MI1394160Medicaid
MI1415458Medicaid
MI1415458Medicaid
MIB44344Medicare UPIN
MIA74650Medicare UPIN
MI1394160Medicaid
MI2500018Medicare PIN
MI0M08720Medicare PIN