Provider Demographics
NPI:1720600786
Name:PANNU, RAJBIR SINGH (MD)
Entity Type:Individual
Prefix:
First Name:RAJBIR
Middle Name:SINGH
Last Name:PANNU
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 1:44405 WOODWARD AVENUE
Mailing Address - Street 2:MEDICAL EDUCATION-H23
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-858-6225
Mailing Address - Fax:248-858-3244
Practice Address - Street 1:44405 WOODWARD AVENUE
Practice Address - Street 2:MEDICAL EDUCATION-H23
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-858-6225
Practice Address - Fax:248-858-3244
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2022-02-03
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-02-03
Provider Licenses
StateLicense IDTaxonomies
MI4351046828390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program