Provider Demographics
NPI:1588696918
Name:VANGALA, KALYANI SWAYAMVARA (MD)
Entity type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:SWAYAMVARA
Last Name:VANGALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BRAMBLE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1730
Mailing Address - Country:US
Mailing Address - Phone:517-337-1595
Mailing Address - Fax:
Practice Address - Street 1:1808 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-1897
Practice Address - Country:US
Practice Address - Phone:517-371-1500
Practice Address - Fax:517-371-1501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082969207RI0200X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7367303OtherAETNA
MI200000026019OtherPHP COMMERCIAL
MI1063041OtherMCLAREN HEALTH ADVANTAGE
MI1063041OtherMCLAREN HEALTH PLAN MEDICAID
MI0M21440079OtherMEDICARE PLUS BLUE
MI1063041OtherMCLAREN HEALTH PLAN COMMERCIAL
MI1103311922OtherBLUE CROSS BLUE SHIELD OF MICHIGAN/BLUE CARE NETWORK
MI200000026019OtherPHP FAMILYCARE
MIM21440079Medicare PIN
MI200000026019OtherPHP COMMERCIAL
MI1103311922OtherBLUE CROSS BLUE SHIELD OF MICHIGAN/BLUE CARE NETWORK