Healthcare Provider Details

I. General information

NPI: 1144961095
Provider Name (Legal Business Name): NISHA NANAVATY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E HOSPITAL DR SPC 4280
ANN ARBOR MI
48109-4280
US

IV. Provider business mailing address

1540 E HOSPITAL DR SPC 4280
ANN ARBOR MI
48109-4280
US

V. Phone/Fax

Practice location:
  • Phone: 734-615-7845
  • Fax:
Mailing address:
  • Phone: 734-615-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301513618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: