Basic Information
| Provider Information | |||||||||
| NPI: | 1972762540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUMMURU | ||||||||
| FirstName: | RAJEEV | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 779 | ||||||||
| Address2: | |||||||||
| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487640779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893629411 | ||||||||
| FaxNumber: | 9893629925 | ||||||||
| Practice Location | |||||||||
| Address1: | 4680 MCLEOD DR E | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897919133 | ||||||||
| FaxNumber: | 9897919135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2008 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036120988 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.