Provider Demographics
NPI:1396756185
Name:PULMONARY AND INTERNAL MEDICINE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:PULMONARY AND INTERNAL MEDICINE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANWAR
Authorized Official - Middle Name:VIRENDER
Authorized Official - Last Name:MENDIRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-358-0011
Mailing Address - Street 1:26699 W 12 MILE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1578
Mailing Address - Country:US
Mailing Address - Phone:248-358-0011
Mailing Address - Fax:248-358-1491
Practice Address - Street 1:26699 W 12 MILE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1578
Practice Address - Country:US
Practice Address - Phone:248-358-0011
Practice Address - Fax:248-358-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
700F37442OtherBLUE CROSS BLUE SHIELD
700F37442OtherBLUE CROSS BLUE SHIELD