Provider Demographics
NPI:1407818594
Name:PANDRANGI, DAMAYANTHI V (MD)
Entity Type:Individual
Prefix:
First Name:DAMAYANTHI
Middle Name:V
Last Name:PANDRANGI
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 1:5155 NORKO DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3021
Mailing Address - Country:US
Mailing Address - Phone:810-230-7532
Mailing Address - Fax:810-230-7764
Practice Address - Street 1:1170 CHARTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3587
Practice Address - Country:US
Practice Address - Phone:810-733-5000
Practice Address - Fax:810-733-5284
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4402239Medicaid
MI4402239Medicaid
0N50450Medicare ID - Type Unspecified