Provider Demographics
NPI:1922083609
Name:LANKA, ARUNA (MD)
Entity Type:Individual
Prefix:
First Name:ARUNA
Middle Name:
Last Name:LANKA
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 1:15500 LUNDY PKWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2778
Mailing Address - Country:US
Mailing Address - Phone:313-586-5011
Mailing Address - Fax:313-792-7134
Practice Address - Street 1:1700 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-7205
Practice Address - Country:US
Practice Address - Phone:734-284-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH 87454Medicare UPIN
KY0560406Medicare ID - Type Unspecified