Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301097882 | MI |
Y | 2080P0205X | Pediatric Endocrinologist | 4301097882 | MI |
NPI | 1376823286 |
---|---|
Provider Name | Shabana Kalladi Puthanpurayil |
First Address | Troy, MI 48084-1744 |
Second Address | Royal Oak, MI 48073-6770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2011 |
Last Update Date | 21/10/2020 |