Healthcare Provider Details

I. General information

NPI: 1083661805
Provider Name (Legal Business Name): NARASIMHA R. GUNDAMRAJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/12/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE LANSING RD SUITE G06
LANSING MI
48912-3756
US

IV. Provider business mailing address

1540 LAKE LANSING RD SUITE G06
LANSING MI
48912-3756
US

V. Phone/Fax

Practice location:
  • Phone: 517-482-7246
  • Fax: 517-484-7377
Mailing address:
  • Phone: 517-482-7246
  • Fax: 517-484-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA92369
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301083310
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4301083310
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: