Healthcare Provider Details

I. General information

NPI: 1124524392
Provider Name (Legal Business Name): ANSHU WADEHRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 E GRAND RIVER AVE STE 102
LANSING MI
48912-4335
US

IV. Provider business mailing address

1536 NAPA
CANTON MI
48187-7700
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-8623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301505488
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: