Individual
RANGANATH ATHRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
2109 HAMILTON RD STE 217, OKEMOS, MI 48864-1700
(517) 580-0575
Mailing address
618 N MAIN ST, STE A, MISHAWAKA, IN 46545-6620
(517) 580-0575
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704204350
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4789569
—
MI
Enumeration date
10/12/2006
Last updated
07/09/2021
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