Individual
RANGARAO PANGULURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-7836
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301051147
MI
207RG0100X
Gastroenterology Physician
Primary
4301051147
MI
207RG0100X
Gastroenterology Physician
A52987
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A529870
—
CA
01
—
100016964
RR MEDICARE
—
01
—
OOA529870424
CAL OPTIMA
—
Enumeration date
12/14/2005
Last updated
01/21/2025
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