Provider Demographics
NPI:1710337886
Name:TIPPARTHY, MEGHANA
Entity Type:Individual
Prefix:
First Name:MEGHANA
Middle Name:
Last Name:TIPPARTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SIXTH ST
Mailing Address - Street 2:C/O PAYER ENROLLMENT
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-392-0388
Mailing Address - Fax:231-935-5885
Practice Address - Street 1:1200 W NORTH DOWN RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-8024
Practice Address - Country:US
Practice Address - Phone:989-344-5910
Practice Address - Fax:231-935-3463
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301110176390200000X
MI4301500804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program