Provider Demographics
NPI:1104928845
Name:KHANDELWAL, PARMANAND (MD)
Entity type:Individual
Prefix:DR
First Name:PARMANAND
Middle Name:
Last Name:KHANDELWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G4007 W COURT ST
Mailing Address - Street 2:STE C
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3560
Mailing Address - Country:US
Mailing Address - Phone:810-720-9000
Mailing Address - Fax:810-720-9002
Practice Address - Street 1:G4007 W COURT ST
Practice Address - Street 2:STE C
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3560
Practice Address - Country:US
Practice Address - Phone:810-720-9000
Practice Address - Fax:810-720-9002
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3416178Medicaid
MIM23560036Medicare PIN
MIA75871Medicare UPIN