Provider Demographics
NPI:1316177876
Name:BHULLAR, JASNEET S (MD)
Entity type:Individual
Prefix:
First Name:JASNEET
Middle Name:S
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46591 ROMEO PLANK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5705
Mailing Address - Country:US
Mailing Address - Phone:586-226-6120
Mailing Address - Fax:586-226-6123
Practice Address - Street 1:1901 STAR BATT DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3767
Practice Address - Country:US
Practice Address - Phone:862-266-1235
Practice Address - Fax:586-226-6123
Is Sole Proprietor?:No
Enumeration Date:2009-07-19
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD461918208C00000X
MI4301504854208C00000X
KY49061208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100361360Medicaid
KYK170760Medicare PIN