Provider Demographics
NPI:1548207467
Name:KULDIP S. DEOGUN, MD, PC
Entity Type:Organization
Organization Name:KULDIP S. DEOGUN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KULDIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-997-5048
Mailing Address - Street 1:PO BOX 33747
Mailing Address - Street 2:DEPT 999437
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-3747
Mailing Address - Country:US
Mailing Address - Phone:248-543-8070
Mailing Address - Fax:
Practice Address - Street 1:43145 SCHOENHERR RD
Practice Address - Street 2:UNIT #13
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1955
Practice Address - Country:US
Practice Address - Phone:586-997-5048
Practice Address - Fax:586-997-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI050E021260OtherBCBS GROUP NUMBER
MI4840071Medicaid
MI0P28890Medicare ID - Type Unspecified