Provider Demographics
NPI:1821102633
Name:MOULI, PADMAJA RANI (MD)
Entity Type:Individual
Prefix:MRS
First Name:PADMAJA
Middle Name:RANI
Last Name:MOULI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1442
Mailing Address - Country:US
Mailing Address - Phone:517-265-2175
Mailing Address - Fax:517-264-5926
Practice Address - Street 1:755 HIGH ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1442
Practice Address - Country:US
Practice Address - Phone:517-265-2175
Practice Address - Fax:517-264-5926
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPM051748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2854819Medicaid
MI2854819Medicaid
MI2854819Medicaid