Provider Demographics
NPI:1730677329
Name:UPADHYAY, JIGAR HARSHADRAY
Entity Type:Individual
Prefix:
First Name:JIGAR
Middle Name:HARSHADRAY
Last Name:UPADHYAY
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 1:5751 FORDHAM CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3347
Mailing Address - Country:US
Mailing Address - Phone:267-234-2503
Mailing Address - Fax:
Practice Address - Street 1:1971 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4255
Practice Address - Country:US
Practice Address - Phone:734-243-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist