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General NPI Number Information
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NPI Number | 1750185849
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Entity Type | Organization
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Legal Business Name | SHANVASECTOMY PLLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 26711 WOODWARD AVE STE LLB
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1370
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Country | US
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Telephone | 313-314-6663
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Fax |
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Provider Business Mailing Address
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Address Line | 26711 WOODWARD AVE STE LLB
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1370
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Country | US
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Telephone | 313-314-6663
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Fax |
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Authorized Official
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Title or Position | CEO/MD
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Name | THULASI SHANMUKANATHAN
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Credential | MD
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Telephone | 313-314-6663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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