Provider Demographics
NPI:1134196850
Name:NANDI, AMIT A (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:A
Last Name:NANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3050 COMMERCE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3819
Mailing Address - Country:US
Mailing Address - Phone:810-385-4441
Mailing Address - Fax:810-385-1540
Practice Address - Street 1:105 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:MI
Practice Address - Zip Code:48097-3460
Practice Address - Country:US
Practice Address - Phone:810-387-9612
Practice Address - Fax:810-387-9611
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068236208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134196850Medicaid
MIG46040090Medicare PIN
MI1134196850Medicaid