Provider Demographics
NPI:1710326681
Name:NAGABHUSHAN, MEGHNA PANNAGA (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGHNA
Middle Name:PANNAGA
Last Name:NAGABHUSHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MEGHNA
Other - Middle Name:PANNAGA
Other - Last Name:NAGABHUSHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:50 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2217
Mailing Address - Country:US
Mailing Address - Phone:248-338-5000
Mailing Address - Fax:
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8000
Practice Address - Fax:314-768-8011
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020531207P00000X
MI5315060020207P00000X
MO2019014148207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine