Individual
DR. BANATHALLY NANJUNDASWAMY NANDISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20206 FARMINGTON RD, LIVONIA, MI 48152-1412
(248) 476-4724
(248) 476-7091
Mailing address
PO BOX 247, NOVI, MI 48376-0247
(248) 449-4032
(734) 737-0974
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301079475
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H26335
MEDICARE
MI
01
—
0P31510
MEDICARE
MI
05
—
4858610
—
MI
Enumeration date
06/19/2006
Last updated
07/23/2019
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