1932178936 NPI number — SALIL S KHANDWALA M.D.

Table of content: SALIL S KHANDWALA M.D. (NPI 1932178936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932178936 NPI number — SALIL S KHANDWALA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHANDWALA
Provider First Name:
SALIL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932178936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22731 NEWMAN STREET
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-982-0200
Provider Business Mailing Address Fax Number:
313-982-0500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22731 NEWMAN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-982-0200
Provider Business Practice Location Address Fax Number:
313-982-0500
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  4301080830 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00318801 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 14370 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0825575 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4851235 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7092103 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G62090 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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