Basic Information
| Provider Information | |||||||||
| NPI: | 1477843431 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NANTHABALAN | ||||||||
| FirstName: | SANGEETHA | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36475 FIVE MILE RD | ||||||||
| Address2: | ST JOSEPH MERCY LIVONIA,DEPARTMENT OF INTERNAL MEDICINE | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481541971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347932470 | ||||||||
| FaxNumber: | 7347932471 | ||||||||
| Practice Location | |||||||||
| Address1: | 36475 FIVE MILE RD | ||||||||
| Address2: | DEPARTMENT OF INTERNAL MEDICINE,ST JOSEPH MERCY LIVONIA | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481541971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347932470 | ||||||||
| FaxNumber: | 7347932471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 06/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301098373 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.