Provider Demographics
NPI:1003109075
Name:VIRUPANNAVAR, SHANTI (DO)
Entity type:Individual
Prefix:DR
First Name:SHANTI
Middle Name:
Last Name:VIRUPANNAVAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2375 WOODLAKE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6021
Mailing Address - Country:US
Mailing Address - Phone:517-908-3600
Mailing Address - Fax:517-908-3601
Practice Address - Street 1:2375 WOODLAKE DR STE 300
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6021
Practice Address - Country:US
Practice Address - Phone:517-908-3600
Practice Address - Fax:517-908-3601
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2024-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine