Individual
THARACKANDATHIL OORAN SHANAVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 KIMOLE LN, SUITE B-1, ADRIAN, MI 49221-1491
(517) 263-6733
(517) 263-7148
Mailing address
901 KIMOLE LN, SUITE B-1, ADRIAN, MI 49221-1491
(517) 263-6733
(517) 263-7148
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
TS034422
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03744
PARAMOUNT
MI
05
—
1099349
—
MI
01
—
115715
CARE CHOICE
MI
01
—
119775
GREAT LAKES OF MI
MI
01
—
18632
HEALTH PLAN OF MI
MI
01
—
350D676100
BLUE CROSS AND BLUE SHIEL
MI
01
—
5450691
AETNA
MI
Enumeration date
05/08/2006
Last updated
12/11/2012
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