Provider Demographics
NPI:1306981014
Name:PANDRANGI, SUSHMA N (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:N
Last Name:PANDRANGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSHMA
Other - Middle Name:N
Other - Last Name:MAGANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE 4003
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-3470
Mailing Address - Fax:734-712-2935
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE 4003
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-3470
Practice Address - Fax:734-712-2935
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1306981014207RN0300X
MI4301078542207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306981014Medicaid