Provider Demographics
NPI:1467564500
Name:RANDHAWA, MUNROOP (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNROOP
Middle Name:
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10019 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-8590
Mailing Address - Country:US
Mailing Address - Phone:810-635-4476
Mailing Address - Fax:810-635-4357
Practice Address - Street 1:3495 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1455
Practice Address - Country:US
Practice Address - Phone:810-424-2007
Practice Address - Fax:810-743-1099
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4507043Medicaid
MIN72340024Medicare PIN
MIH46206Medicare UPIN