Healthcare Provider Details

I. General information

NPI: 1053481853
Provider Name (Legal Business Name): YAMINI RAMALINGAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 S STATE RD
GOODRICH MI
48438-9292
US

IV. Provider business mailing address

444 ASHLEY DR
GRAND BLANC MI
48439-1553
US

V. Phone/Fax

Practice location:
  • Phone: 810-636-2231
  • Fax: 810-636-7174
Mailing address:
  • Phone: 810-636-2231
  • Fax: 810-636-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301080418
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: