Provider Demographics
NPI:1477843431
Name:NANTHABALAN, SANGEETHA (MD)
Entity Type:Individual
Prefix:
First Name:SANGEETHA
Middle Name:
Last Name:NANTHABALAN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:36475 FIVE MILE RD
Mailing Address - Street 2:ST JOSEPH MERCY LIVONIA,DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1971
Mailing Address - Country:US
Mailing Address - Phone:734-793-2470
Mailing Address - Fax:734-793-2471
Practice Address - Street 1:36475 FIVE MILE RD
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE,ST JOSEPH MERCY LIVONIA
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-793-2470
Practice Address - Fax:734-793-2471
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2016-06-20
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Provider Licenses
StateLicense IDTaxonomies
MI4301098373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine