Organization
ANANTH SHANMUGAM MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY POORE (BILLER)
(916) 452-6682
Entity
Organization
Contact information
Practice address
8001 BRUCEVILLE RD, SACRAMENTO, CA 95823-2329
(916) 452-6682
(916) 452-6683
Mailing address
8001 BRUCEVILLE RD, SACRAMENTO, CA 95823-2329
(916) 452-6682
(916) 452-6683
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A90579
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A905790
MEDICARE PTAN
CA
Enumeration date
06/30/2010
Last updated
07/28/2010
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