Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 5101019203 | MI |
Y | 111NI0900X | Internist | 5101019203 | MI |
NPI | 1003109075 |
---|---|
Provider Name | Dr. Shanti Virupannavar |
First Address | Lansing, MI 48910-5894 |
Second Address | East Lansing, MI 48824-1376 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2011 |
Last Update Date | 13/09/2016 |