MEDICARE: DR. PURNACHANDER RAO VANGALA M.D.,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2016-01861	NC
2	207R00000X	Internal Medicine Physician	4301094738	MI

General Provider Information

NPI Number	:	1740412626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PURNACHANDER RAO VANGALA M.D.,

Provider Business Mailing Address
First Line	:	31095 FLORALVIEW DR S APT 105
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-5863
Country	:	US
Telephone Number	:	616-206-0159
Fax Number	:

Provider Business Practice Location Address
First Line	:	31095 FLORALVIEW DR S
Second Line	:	105
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-5862
Country	:	US
Telephone Number	:	616-206-0159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	04/17/2026

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