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Individual

AJANTHAN SIVAGURUNATHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
210 NORTH LAFAYETTE, PROVIDENCE MEDICAL CENTER - SOUTH LYON,, SOUTH LYON, MI 48178
(248) 437-1744
(248) 437-3245
Mailing address
210 NORTH LAFAYETTE, PROVIDENCE MEDICAL CENTER - SOUTH LYON,, SOUTH LYON, MI 48178
(248) 437-1744
(248) 437-3245

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
05/23/2013
Last updated
03/27/2014
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