Provider Demographics
NPI:1760726384
Name:SINGH, CHARNPREET (PT)
Entity Type:Individual
Prefix:
First Name:CHARNPREET
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7633 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3730
Mailing Address - Country:US
Mailing Address - Phone:313-651-7170
Mailing Address - Fax:313-824-2724
Practice Address - Street 1:19785 W 12 MILE ROAD
Practice Address - Street 2:SUITE 675
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2584
Practice Address - Country:US
Practice Address - Phone:248-213-8294
Practice Address - Fax:248-443-0165
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P12330OtherMEDICARE GROUP PIN -IHG
MI5501016113OtherPT STATE LICENSE
MI1760726384OtherTYPE 1 NPI #
MIOH28276OtherTYPE 2 BCBS PIN- IHG
MI12476799OtherCAQH PROVIDER ID
MIOH70561OtherTYPE 1 BCBS PIN
MI1144562083OtherTYPE 2 NPI #- IHG PT GROUP
MI010822105OtherIHG TAX ID#