Provider Demographics
NPI:1780682831
Name:SANDHU, PRITPAL GILL (MD)
Entity type:Individual
Prefix:
First Name:PRITPAL
Middle Name:GILL
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3851 WEST RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2350
Mailing Address - Country:US
Mailing Address - Phone:734-675-5100
Mailing Address - Fax:734-692-5787
Practice Address - Street 1:3851 WEST RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2350
Practice Address - Country:US
Practice Address - Phone:734-675-5100
Practice Address - Fax:734-692-5787
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIPS060265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108237922OtherBCBS OF MICHIGAN
MI4533740Medicaid
MIC4026OtherMCARE
MI0M20150Medicare PIN
MIC4026OtherMCARE