Provider Demographics
NPI:1386632875
Name:KHULLAR, SUBHASH C (MD)
Entity type:Individual
Prefix:DR
First Name:SUBHASH
Middle Name:C
Last Name:KHULLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2632 S ROCHESTER RD
Mailing Address - Street 2:UNIT 70306
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-7914
Mailing Address - Country:US
Mailing Address - Phone:586-274-0123
Mailing Address - Fax:586-274-1125
Practice Address - Street 1:1629 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3542
Practice Address - Country:US
Practice Address - Phone:586-274-0123
Practice Address - Fax:586-274-1125
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2018-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301040148207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110500486OtherBCBS
MI4752166Medicaid
MI4752166Medicaid
B43318Medicare UPIN