Provider Demographics
NPI:1952890881
Name:MURTHY, ANAND
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:
Last Name:MURTHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 HOSPITAL DRIVE
Mailing Address - Street 2:G1218 TOWSLEY, SPC 5222
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5222
Mailing Address - Country:US
Mailing Address - Phone:734-232-6048
Mailing Address - Fax:
Practice Address - Street 1:1500 E. MEDICAL CENTER DR.
Practice Address - Street 2:C213 MEDINN, SPC 5831
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5831
Practice Address - Country:US
Practice Address - Phone:734-936-5950
Practice Address - Fax:734-232-5015
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103613122300000X
MI4351048786390200000X
MI2951000797390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentistGroup - Single Specialty