Individual
DR. DAVID KIRAN THAMBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3333 EVERGREEN DR. NE, GRAND RAPIDS, MI 49525-9756
(616) 364-4200
(616) 364-7347
Mailing address
3333 EVERGREEN DR. NE, GRAND RAPIDS, MI 49525-9756
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
13978-320
WI
207L00000X
Anesthesiology Physician
Primary
4301082815
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0411310
BCBS PIN
MI
05
—
4561057
—
MI
01
—
DT082815
BCBS LICENSE NUMBER
MI
01
—
P00067881
RAILROAD MEDICARE
MI
Enumeration date
04/14/2006
Last updated
12/17/2025
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