Provider Demographics
NPI:1518665140
Name:PANDYA, KUSH
Entity Type:Individual
Prefix:
First Name:KUSH
Middle Name:
Last Name:PANDYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6379 ROSE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2223
Mailing Address - Country:US
Mailing Address - Phone:248-767-8431
Mailing Address - Fax:
Practice Address - Street 1:1260 E WOODLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3956
Practice Address - Country:US
Practice Address - Phone:610-690-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program