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General NPI Number Information
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NPI Number | 1659827467
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE GYNECOLOGY PLLC
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 2345 S HURON PKWY
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City | ANN ARBOR
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State | MI
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Zip | 48104-5124
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Country | US
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Telephone | 734-418-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 BARRISTER ROAD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2820
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Country | US
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Telephone | 734-418-2188
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Fax |
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Authorized Official
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Title or Position | GYNECOLOGY
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Name | SUMAN TEWARI
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Credential | MD
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Telephone | 734-418-2188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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