Provider Demographics
NPI:1366709198
Name:PAULEENA SINGH-GANDRETI M.D.,P.C
Entity type:Organization
Organization Name:PAULEENA SINGH-GANDRETI M.D.,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULEENA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-635-4441
Mailing Address - Street 1:6405 TELEGRAPH RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1716
Mailing Address - Country:US
Mailing Address - Phone:248-760-5234
Mailing Address - Fax:248-203-7011
Practice Address - Street 1:6405 TELEGRAPH RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1716
Practice Address - Country:US
Practice Address - Phone:248-760-5234
Practice Address - Fax:248-203-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086958261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1568634517OtherINDIVIDUAL NPI