Provider Demographics
NPI:1669417408
Name:DHALIWAL, AVNINDER SINGH (MD)
Entity type:Individual
Prefix:
First Name:AVNINDER
Middle Name:SINGH
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1441 WOODLAND PL
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1534
Mailing Address - Country:US
Mailing Address - Phone:248-534-5692
Mailing Address - Fax:
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-697-2822
Practice Address - Fax:888-443-3187
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301078429207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I33756Medicare UPIN