Provider Demographics
NPI:1730220757
Name:AMIN, JAGATBHAI A (MD)
Entity type:Individual
Prefix:
First Name:JAGATBHAI
Middle Name:A
Last Name:AMIN
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 1:43171 DALCOMA DR
Mailing Address - Street 2:STE 11
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6307
Mailing Address - Country:US
Mailing Address - Phone:586-792-5300
Mailing Address - Fax:586-792-5930
Practice Address - Street 1:43171 DALCOMA DR
Practice Address - Street 2:STE 11
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6307
Practice Address - Country:US
Practice Address - Phone:586-792-5300
Practice Address - Fax:586-792-5930
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035463207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2105075Medicaid
MIB 45034Medicare UPIN
MI2105075Medicaid