Provider Demographics
NPI:1740412626
Name:VANGALA, PURNACHANDER RAO (MD,)
Entity Type:Individual
Prefix:DR
First Name:PURNACHANDER
Middle Name:RAO
Last Name:VANGALA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31095 FLORAL VIEW DRIVE SOUTH, 105
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1784
Mailing Address - Country:US
Mailing Address - Phone:616-206-0159
Mailing Address - Fax:
Practice Address - Street 1:31095 FLORALVIEW DR S
Practice Address - Street 2:105
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-5862
Practice Address - Country:US
Practice Address - Phone:616-206-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine