Provider Demographics
NPI:1215937222
Name:DAVE, HIMANSHU CHANDRAKANT
Entity type:Individual
Prefix:MR
First Name:HIMANSHU
Middle Name:CHANDRAKANT
Last Name:DAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43681 GROUSE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7413
Mailing Address - Country:US
Mailing Address - Phone:586-362-6535
Mailing Address - Fax:586-461-4088
Practice Address - Street 1:43681 GROUSE DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-7413
Practice Address - Country:US
Practice Address - Phone:586-362-6535
Practice Address - Fax:586-461-4088
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N72040Medicare ID - Type UnspecifiedPHYSICAL THERAPIST (SOLO)