Healthcare Provider Details

I. General information

NPI: 1144342320
Provider Name (Legal Business Name): RUMANA ANIS BARODAWALLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S ADAMS ST
MT PLEASANT MI
48858-2207
US

IV. Provider business mailing address

709 S ADAMS ST
MT PLEASANT MI
48858-2207
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-7774
  • Fax: 989-772-7220
Mailing address:
  • Phone: 989-772-7774
  • Fax: 989-772-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301068018
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: