# CENTER FOR INDIVIDUALIZED MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760814289
- **Authorized official:** SURJIT S MAHAL MD (OWNER)
- **Authorized official phone:** (734) 324-8000

## Contact information

- **Practice address:** 1404 BIDDLE AVE, WYANDOTTE, MI 48192-3706
- **Practice address phone:** (734) 624-8000
- **Practice address fax:** (734) 326-1443
- **Mailing address:** PO BOX 251921, WEST BLOOMFIELD, MI 48325-1921
- **Mailing address phone:** (734) 324-8000
- **Mailing address fax:** (734) 324-0993

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 4301046425 | MI | Yes |

## Other

- **Enumeration date:** 08/07/2013
- **Last updated:** 08/07/2013