Individual
NISHTA POLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
965 WILSON RD RM A233, EAST LANSING, MI 48824-6410
(517) 353-4362
(517) 432-0927
Mailing address
4540 HUNT CLUB DR APT 1A, YPSILANTI, MI 48197-9097
(804) 332-9010
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5151016993
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2024
Last updated
06/03/2024
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