Healthcare Provider Details

I. General information

NPI: 1568678878
Provider Name (Legal Business Name): PARTHA S MOOKERJEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PARTHA SARATHI MUKHOPADHYAY M.D.

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE SUITE 370
LANSING MI
48912-1800
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-484-4451
  • Fax: 517-484-0291
Mailing address:
  • Phone: 517-253-6320
  • Fax: 517-253-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number4301052990
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: