Provider Demographics
NPI:1568840510
Name:BANERJEE, AVIRAJ
Entity Type:Individual
Prefix:MR
First Name:AVIRAJ
Middle Name:
Last Name:BANERJEE
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 1:644 S SPINNINGWHEEL LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1322
Mailing Address - Country:US
Mailing Address - Phone:248-200-8064
Mailing Address - Fax:
Practice Address - Street 1:644 S SPINNINGWHEEL LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48304-1322
Practice Address - Country:US
Practice Address - Phone:248-200-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist