Provider Demographics
NPI:1518011451
Name:PANNU, BALJINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:BALJINDER
Middle Name:
Last Name:PANNU
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 1:475 GOODHUE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48034-3424
Mailing Address - Country:US
Mailing Address - Phone:248-885-7889
Mailing Address - Fax:
Practice Address - Street 1:333 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1107
Practice Address - Country:US
Practice Address - Phone:248-885-7889
Practice Address - Fax:586-540-0017
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066542207Q00000X, 207QG0300X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG14195Medicare UPIN