Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | RP073528 | MI |
NPI | 1376517359 |
---|---|
Provider Name | Ravinder R Polasani |
First Address | Battle Creek, MI 49017-2331 |
Second Address | Jackson, MI 49202-2981 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 29/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104078155 | (05) | MI |
G40082 | (02) | MI |