Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301099825 | MI |
N | 111NI0900X | Internist | 4301099825 | MI |
N | 207R00000X | Internist | A100651 | CA |
N | 111NI0900X | Internist | A100651 | CA |
Y | 207RN0300X | Nephrologist | 4301099825 | MI |
N | 207RN0300X | Nephrologist | A100651 | CA |
N | 208000000X | Pediatrician | 4301099825 | MI |
N | 208000000X | Pediatrician | A100651 | CA |
NPI | 1053577973 |
---|---|
Provider Name | Dr. Anna Vachaparampil Mathew |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2008 |
Last Update Date | 13/12/2011 |