Provider Demographics
NPI:1568454254
Name:ZAMPANI, RATNA K (MD)
Entity Type:Individual
Prefix:
First Name:RATNA
Middle Name:K
Last Name:ZAMPANI
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 1:20206 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1412
Mailing Address - Country:US
Mailing Address - Phone:248-476-4724
Mailing Address - Fax:248-476-7091
Practice Address - Street 1:20206 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1412
Practice Address - Country:US
Practice Address - Phone:248-476-4724
Practice Address - Fax:248-476-7091
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1911536Medicaid
MI1911536Medicaid
MID83194Medicare UPIN