Individual
ANJALI MODI MANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503
(616) 391-1609
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 631-5828
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301101534
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301101534
MI
Other
Enumeration date
06/26/2012
Last updated
08/06/2018
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