MEDICARE: AISHWARIYA MUDUNURI

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	363A00000X	Physician Assistant	5601013544	MI

General Provider Information

NPI Number	:	1811851470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISHWARIYA MUDUNURI

Provider Business Mailing Address
First Line	:	6185 SMITHFIELD DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-1081
Country	:	US
Telephone Number	:	248-878-1032
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 S MAPLE RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-3833
Country	:	US
Telephone Number	:	734-794-3494
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ AISHWARIYA MUDUNURI ” Practice Location

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