Healthcare Provider Details

I. General information

NPI: 1467397703
Provider Name (Legal Business Name): ANITA KANGARLU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N LAFAYETTE ST
SOUTH LYON MI
48178-2048
US

IV. Provider business mailing address

210 N LAFAYETTE ST
SOUTH LYON MI
48178-2048
US

V. Phone/Fax

Practice location:
  • Phone: 248-437-6300
  • Fax: 248-437-3245
Mailing address:
  • Phone: 248-437-6300
  • Fax: 248-437-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351056809APP26
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: