Provider Demographics
NPI:1366894818
Name:SANDHU, GAGANJOT (MD)
Entity type:Individual
Prefix:DR
First Name:GAGANJOT
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16001 W NINE MILE RD
Mailing Address - Street 2:GENERAL SURGERY DEPARTMENT
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-849-8902
Mailing Address - Fax:248-849-5380
Practice Address - Street 1:16001 W. NINE MILER ROAD
Practice Address - Street 2:PROVIDENCE-PROVIDENCE PARK HOSPITALS - SOUTHFIELD
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48074
Practice Address - Country:US
Practice Address - Phone:248-849-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301110066390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program