Provider Demographics
NPI:1861094047
Name:PRANAVMJAGTAPMD PLLC
Entity type:Organization
Organization Name:PRANAVMJAGTAPMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRANAV
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAGTAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:947-207-1076
Mailing Address - Street 1:36400 WOODWARD AVE # 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0911
Mailing Address - Country:US
Mailing Address - Phone:947-207-1076
Mailing Address - Fax:
Practice Address - Street 1:36400 WOODWARD AVE # 101
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0911
Practice Address - Country:US
Practice Address - Phone:947-207-1076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty