Provider Demographics
NPI:1295891067
Name:SACHDEVA, JAGDISH KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:JAGDISH
Middle Name:KUMAR
Last Name:SACHDEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15105 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195
Mailing Address - Country:US
Mailing Address - Phone:734-283-4122
Mailing Address - Fax:734-282-7577
Practice Address - Street 1:15105 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195
Practice Address - Country:US
Practice Address - Phone:734-283-4122
Practice Address - Fax:734-282-7577
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS033632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1848773Medicaid
0Q26263001Medicare ID - Type Unspecified
B47301Medicare UPIN