Provider Demographics
NPI:1801005145
Name:LINGAM, NATESH (MD)
Entity Type:Individual
Prefix:DR
First Name:NATESH
Middle Name:
Last Name:LINGAM
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 1:133 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2308
Mailing Address - Country:US
Mailing Address - Phone:586-468-1600
Mailing Address - Fax:586-465-0329
Practice Address - Street 1:133 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2308
Practice Address - Country:US
Practice Address - Phone:586-468-1600
Practice Address - Fax:586-465-0329
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079815207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E04360OtherBLUE CROSS BLUE SHIELDS OF MICHIGAN
MIMI8102011Medicare PIN