Provider Demographics
NPI:1508356346
Name:AGGARWAL, ANKITA
Entity Type:Individual
Prefix:
First Name:ANKITA
Middle Name:
Last Name:AGGARWAL
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 1:22250 PROVIDENCE DR STE 705
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6215
Mailing Address - Country:US
Mailing Address - Phone:248-552-9858
Mailing Address - Fax:
Practice Address - Street 1:22250 PROVIDENCE DR STE 705
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6215
Practice Address - Country:US
Practice Address - Phone:248-552-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2021-07-06
Deactivation Date:2019-01-09
Deactivation Code:
Reactivation Date:2019-01-24
Provider Licenses
StateLicense IDTaxonomies
MI4351033280207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease