Basic Information
| Provider Information | |||||||||
| NPI: | 1790915965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGABHUSHANA | ||||||||
| FirstName: | ANANTHAMURTHY | ||||||||
| MiddleName: | HANIYA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, FRCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3990 JOHN R ST | ||||||||
| Address2: | BOX 162 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457233 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4201 SAINT ANTOINE ST | ||||||||
| Address2: | DRH/UHC SUIT 3J.1.1 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454300 | ||||||||
| FaxNumber: | 3137454777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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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 | 207L00000X | 4301094247 | MI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.