MEDICARE: DR. POOJA TANGRI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301062508	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350440031-2	OTHER	MI	BLUE CROSS BLUE SHIELD
2	5663131	OTHER	MI	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	G24826	OTHER	MI	HAP
5	18T55048	OTHER	MI	HEALTH PLUS
6	1982107005	OTHER	MI	CIGNA
7	C5896	OTHER	MI	MCARE
8	G24826	OTHER	MI	HEALTH NET FEDERAL SERVIC

General Provider Information

NPI Number	:	1306828652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. POOJA TANGRI MD

Provider Business Mailing Address
First Line	:	401 S BALLENGER HWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3638
Country	:	US
Telephone Number	:	810-342-1000
Fax Number	:	810-342-1590

Provider Business Practice Location Address
First Line	:	809 W DRYDEN RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-8961
Country	:	US
Telephone Number	:	810-678-4000
Fax Number	:	810-678-4077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. POOJA TANGRI MD” Practice Location

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