Provider Demographics
NPI:1306828652
Name:TANGRI, POOJA (MD)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:
Last Name:TANGRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:809 W DRYDEN RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8961
Practice Address - Country:US
Practice Address - Phone:810-678-4000
Practice Address - Fax:810-678-4077
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350440031-2OtherBLUE CROSS BLUE SHIELD
MI5663131OtherAETNA
MI3304289Medicaid
MIG24826OtherHAP
MI18T55048OtherHEALTH PLUS
MI1982107005OtherCIGNA
MIC5896OtherMCARE
MIG24826OtherHEALTH NET FEDERAL SERVIC
MIG24826OtherHAP
MIOM28420008Medicare ID - Type Unspecified