Individual
DOMIAN KANDAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5059
Mailing address
307 S EVERGREEN AVE, WOODBURY, NJ 08096-2739
(856) 686-4308
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101008716
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
008716
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000552888
ANTHEM/BCBS
OH
05
—
112905533
—
MI
05
—
112905749
—
MI
05
—
112905758
—
MI
05
—
114206077
—
MI
05
—
114218327
—
MI
05
—
2791439
—
OH
01
—
DK008716
BLUE SHIELD
MI
01
—
P00427186
MEDICARE RAILROAD
OH
Enumeration date
06/01/2006
Last updated
02/13/2023
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