Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301063102 | MI |
N | 111NI0900X | Internist | 4301063102 | MI |
N | 207RI0200X | Infectious Disease | 4301063102 | MI |
NPI | 1063426922 |
---|---|
Provider Name | Jambunathan Ramanathan |
First Address | Troy, MI 48098-6314 |
Second Address | Detroit, MI 48201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 26/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4726068 | (05) | MI |
R67353 | (02) |