Provider Demographics
NPI:1407962467
Name:GHANDHI, BURJOR D (MD)
Entity Type:Individual
Prefix:DR
First Name:BURJOR
Middle Name:D
Last Name:GHANDHI
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 1:722 NOTRE DAME ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1240
Mailing Address - Country:US
Mailing Address - Phone:313-885-5070
Mailing Address - Fax:313-885-0258
Practice Address - Street 1:722 NOTRE DAME ST
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1240
Practice Address - Country:US
Practice Address - Phone:313-885-5070
Practice Address - Fax:313-885-0258
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBG032398207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6047846Medicaid
B44716Medicare UPIN
MI6047846Medicaid