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General NPI Number Information
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NPI Number | 1013128925
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Entity Type | Individual
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Provider Name | NAYANTARA JNANANAND M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 8552 N CANTON CENTER RD
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City | CANTON
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State | MI
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Zip | 48187-1310
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Country | US
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Telephone | 248-910-4123
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Fax | 888-378-0244
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Provider Business Mailing Address
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Address Line | 50936 RICHARD DR
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City | PLYMOUTH
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State | MI
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Zip | 48170-1192
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Country | US
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Telephone | 248-910-4123
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Fax | 888-378-0244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V2631
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301085579
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License Number State | MI
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