Provider Demographics
NPI:1659347888
Name:NANDI, HEMALATA A (MD)
Entity Type:Individual
Prefix:
First Name:HEMALATA
Middle Name:A
Last Name:NANDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1600 GRATIOT BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1145
Mailing Address - Country:US
Mailing Address - Phone:810-364-9916
Mailing Address - Fax:810-364-9903
Practice Address - Street 1:1600 GRATIOT BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1145
Practice Address - Country:US
Practice Address - Phone:810-364-9916
Practice Address - Fax:810-364-9903
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301075494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1659347888Medicaid
I50713Medicare UPIN