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Individual

DR. JEETENDER SINGH MATHARU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
7250 DIXIE HWY, SUITE 100, CLARKSTON, MI 48346-5108
(248) 620-3500
(248) 620-3503
Mailing address
7250 DIXIE HWY, SUITE 100, CLARKSTON, MI 48346-5108
(248) 620-3500
(248) 620-3503

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301070179
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0806300321
BCBS
MI
05
4483424
MI
Enumeration date
01/16/2006
Last updated
01/26/2012
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