Provider Demographics
NPI:1760507081
Name:H. PANDYA MD PC
Entity Type:Organization
Organization Name:H. PANDYA MD PC
Other - Org Name:LAKESHORE GASTRO ENTROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MRADULA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-778-6090
Mailing Address - Street 1:28300 HARPER AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-778-6090
Mailing Address - Fax:586-778-1943
Practice Address - Street 1:28300 HARPER AVE.
Practice Address - Street 2:
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-778-6090
Practice Address - Fax:586-778-1943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H. PANDYA MD PC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHP047131207RG0100X
207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty