Individual
SHANTHINI AMBROSE DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
119 S KALAMAZOO ST, WHITE PIGEON, MI 49099-8149
(269) 483-7624
(269) 483-7905
Mailing address
711 S HEALTH PKWY, SUITE L-7, THREE RIVERS, MI 49093-9387
(269) 273-9723
(269) 273-9746
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301041793
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4262684 10
—
MI
Enumeration date
11/14/2005
Last updated
02/26/2010
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