Provider Demographics
NPI:1407822810
Name:GURSHARN S DOSANJH MD PC
Entity Type:Organization
Organization Name:GURSHARN S DOSANJH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:GURSHARN
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:DOSANJH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-531-1871
Mailing Address - Street 1:3181 PRAIRIE ST SW
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2097
Mailing Address - Country:US
Mailing Address - Phone:616-531-1871
Mailing Address - Fax:616-531-7323
Practice Address - Street 1:3181 PRAIRIE ST SW
Practice Address - Street 2:SUITE 101B
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2097
Practice Address - Country:US
Practice Address - Phone:616-531-1871
Practice Address - Fax:616-531-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGD046835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104798002Medicaid
MI1104101502OtherBLUE CROSS BLUE SHIELD
MIN91250001Medicare ID - Type Unspecified
MI104798002Medicaid