Healthcare Provider Details

I. General information

NPI: 1720604705
Provider Name (Legal Business Name): MANASVI PINNAMANENI RITCHIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANASVI PINNAMANENI MD

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

1985 UNION AVE APT 3D
BENTON HARBOR MI
49022-6272
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-0857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: