Provider Demographics
NPI:1346288750
Name:DEOGUN, KULDIP S (MD)
Entity Type:Individual
Prefix:
First Name:KULDIP
Middle Name:S
Last Name:DEOGUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0047
Mailing Address - Country:US
Mailing Address - Phone:248-543-8070
Mailing Address - Fax:
Practice Address - Street 1:43145 SCHOENHERR RD
Practice Address - Street 2:UNIT #13
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1955
Practice Address - Country:US
Practice Address - Phone:586-997-5048
Practice Address - Fax:586-997-5049
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041483207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0505018431OtherBCBS
MI4840071-10Medicaid
MI5836031OtherAETNA
MI4840071-10Medicaid
MIE38494Medicare UPIN