Individual
CHARNPREET SINGH DHALIWAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
19785 W 12 MILE ROAD, SUITE 675, SOUTHFIELD, MI 48076-2584
(248) 213-8294
(248) 443-0165
Mailing address
7633 E JEFFERSON AVE STE 200, DETROIT, MI 48214-3732
(313) 651-7170
(313) 824-2724
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501016113
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010822105
IHG TAX ID#
MI
01
—
0P12330
MEDICARE GROUP PIN -IHG
MI
01
—
1144562083
TYPE 2 NPI #- IHG PT GROUP
MI
01
—
12476799
CAQH PROVIDER ID
MI
01
—
1760726384
TYPE 1 NPI #
MI
01
—
5501016113
PT STATE LICENSE
MI
01
—
OH28276
TYPE 2 BCBS PIN- IHG
MI
01
—
OH70561
TYPE 1 BCBS PIN
MI
Enumeration date
11/20/2012
Last updated
01/08/2026
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