Provider Demographics
NPI:1841385614
Name:THANGAMANI, BHUVARAGHAMURTHY (MD)
Entity type:Individual
Prefix:DR
First Name:BHUVARAGHAMURTHY
Middle Name:
Last Name:THANGAMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:THANGAMANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 E WASHINGTON ST
Mailing Address - Street 2:STE 204
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846
Mailing Address - Country:US
Mailing Address - Phone:616-527-8293
Mailing Address - Fax:616-527-5718
Practice Address - Street 1:550 E WASHINGTON ST
Practice Address - Street 2:STE 204
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846
Practice Address - Country:US
Practice Address - Phone:616-527-8293
Practice Address - Fax:616-527-5718
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBT039404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI02630OtherPRIORITY HEALTH PAY TO ER
MI103176376Medicaid
MI104425037Medicaid
MI200000000909OtherPHPMM HOSPITAL
MI200000004612OtherPHPMM OFFICE
MI3176376OtherMOLINA
MI700C460070OtherBCBS OFFICE GROUP
MI1003025OtherMCLAREN
MI383218134OtherTRICARE
MI35937OtherP HEALTH OFFICE PAY TO
MI700C460060OtherBCBS GROUP
MI104425037Medicaid
MI700C460070OtherBCBS OFFICE GROUP
MI02630OtherPRIORITY HEALTH PAY TO ER