Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | RA056534 | MI |
NPI | 1205867967 |
---|---|
Provider Name | Dr. Ramesh Babu Avula |
First Address | East Lansing, MI 48823-7378 |
Second Address | Lansing, MI 48912-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 26/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103255569 | (05) | MI |
G30183 | (02) | MI |