Provider Demographics
NPI:1477143378
Name:NAROLA, KAJAL BHAVESH
Entity Type:Individual
Prefix:
First Name:KAJAL
Middle Name:BHAVESH
Last Name:NAROLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49578 E CENTRAL PARK
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-2412
Mailing Address - Country:US
Mailing Address - Phone:269-589-9659
Mailing Address - Fax:248-522-7916
Practice Address - Street 1:49578 E CENTRAL PARK
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-2412
Practice Address - Country:US
Practice Address - Phone:269-589-9659
Practice Address - Fax:248-522-7916
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501019940OtherSTATE OF MICHIGAN