Provider Demographics
NPI:1568678878
Name:MOOKERJEE, PARTHA S (MD)
Entity type:Individual
Prefix:
First Name:PARTHA
Middle Name:S
Last Name:MOOKERJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PARTHA
Other - Middle Name:SARATHI
Other - Last Name:MUKHOPADHYAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-253-6320
Mailing Address - Fax:517-253-6321
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-484-4451
Practice Address - Fax:517-484-0291
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052990207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2010157Medicaid
MI0826225Medicare PIN
MIG21983Medicare UPIN