Provider Demographics
NPI:1497906879
Name:PANCHAL, BRIJESH RAMESHCHANDRA (PT)
Entity Type:Individual
Prefix:
First Name:BRIJESH
Middle Name:RAMESHCHANDRA
Last Name:PANCHAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3793
Mailing Address - Country:US
Mailing Address - Phone:517-768-0883
Mailing Address - Fax:517-768-0673
Practice Address - Street 1:2545 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3793
Practice Address - Country:US
Practice Address - Phone:517-768-0883
Practice Address - Fax:517-768-0673
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013623173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine