Provider Demographics
NPI:1558331884
Name:MAHAL, SURJIT SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:SURJIT
Middle Name:SINGH
Last Name:MAHAL
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 1:1404 BIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3706
Mailing Address - Country:US
Mailing Address - Phone:734-324-8000
Mailing Address - Fax:734-324-0993
Practice Address - Street 1:1404 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3706
Practice Address - Country:US
Practice Address - Phone:734-324-8000
Practice Address - Fax:734-324-0993
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010464252084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689434Medicaid
MIA77184Medicare UPIN
0M77590Medicare PIN