Healthcare Provider Details

I. General information

NPI: 1568657146
Provider Name (Legal Business Name): NITI THAKUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 PINE HOLLOW DR SUITE 400
EAST LANSING MI
48823-9700
US

IV. Provider business mailing address

6200 PINE HOLLOW DR SUITE 400
EAST LANSING MI
48823-9700
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-1676
  • Fax: 517-339-2716
Mailing address:
  • Phone: 517-339-1676
  • Fax: 517-339-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301055581
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: