Provider Demographics
NPI:1619965035
Name:SINGH-SANDHU, MOHINDER PAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHINDER
Middle Name:PAL
Last Name:SINGH-SANDHU
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 1:3851 WEST RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2350
Mailing Address - Country:US
Mailing Address - Phone:734-671-3248
Mailing Address - Fax:734-671-1819
Practice Address - Street 1:3851 WEST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2350
Practice Address - Country:US
Practice Address - Phone:734-671-3248
Practice Address - Fax:734-671-1819
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS036206207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2103310Medicaid
MI2103310Medicaid
MIQ24657039Medicare PIN
MIA77442Medicare UPIN