Organization
CENTER FOR INDIVIDUALIZED MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SURJIT S MAHAL MD (OWNER)
(734) 324-8000
Entity
Organization
Contact information
Practice address
1404 BIDDLE AVE, WYANDOTTE, MI 48192-3706
(734) 624-8000
(734) 326-1443
Mailing address
PO BOX 251921, WEST BLOOMFIELD, MI 48325-1921
(734) 324-8000
(734) 324-0993
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
4301046425
MI
Other
Enumeration date
08/07/2013
Last updated
08/07/2013
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