Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301077085 | MI |
N | 111NI0900X | Internist | 4301077085 | MI |
Y | 207RH0003X | Hematology & Oncology | 4301077085 | MI |
NPI | 1033215967 |
---|---|
Provider Name | Dr. Usha Sree Chamarthy |
First Address | Lansing, MI 48901-3008 |
Second Address | Lansing, MI 48912-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 19/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1103311651 | BCBS INDIVIDUAL PIN (01) | MI |
4663020 | (05) | MI |
G89703 | (02) | MI |