Healthcare Provider Details

I. General information

NPI: 1609920354
Provider Name (Legal Business Name): MADHU AJIT SUBNANI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 N CEDAR ST
IMLAY CITY MI
48444-1166
US

IV. Provider business mailing address

542 N CEDAR ST
IMLAY CITY MI
48444-1166
US

V. Phone/Fax

Practice location:
  • Phone: 810-724-0480
  • Fax: 810-724-4482
Mailing address:
  • Phone: 810-724-0480
  • Fax: 810-724-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number4301055014
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: