Individual
ANNETTE VANNILAM
Active
Individual
ANNETTE VANNILAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301103398
MI
2080P0206X
Pediatric Gastroenterology Physician
Primary
75930
CT
2080P0206X
Pediatric Gastroenterology Physician
MD0000054575
TN
261QP2300X
Primary Care Clinic/Center
4301103398
MI
Other
Enumeration date
06/17/2013
Last updated
09/04/2024
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