Healthcare Provider Details

I. General information

NPI: 1881001055
Provider Name (Legal Business Name): RANGA PRASANTH THIRUVENKATARAMANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

804 SERVICE RD STE A109B
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2468
  • Fax: 517-364-3994
Mailing address:
  • Phone: 517-364-2468
  • Fax: 517-364-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301111821
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: