Basic Information
| Provider Information | |||||||||
| NPI: | 1780654343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NALLANI | ||||||||
| FirstName: | GOPI | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5987 | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486030987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894014245 | ||||||||
| FaxNumber: | 9894014235 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 N CENTER RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486037920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897539000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4301070426 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4499630 | 05 | MI | MEDICAID |