| Shanvasectomy Pllc | |
|
26711 Woodward Ave Ste Llb Huntington Woods MI 48070-1370 | |
| (313) 314-6663 | |
| Not Available |
| Full Name | Shanvasectomy Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 26711 Woodward Ave Ste Llb, Huntington Woods, Michigan |
| Authorized Official Name and Position | Thulasi Shanmukanathan (CEO/MD) |
| Authorized Official Contact | 3133146663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shanvasectomy Pllc 26711 Woodward Ave Ste Llb Huntington Woods MI 48070-1370 Ph: (313) 314-6663 | Shanvasectomy Pllc 26711 Woodward Ave Ste Llb Huntington Woods MI 48070-1370 Ph: (313) 314-6663 |
| NPI Number | 1750185849 |
|---|---|
| Provider Enumeration Date | 04/01/2025 |
| Last Update Date | 04/01/2025 |
| Medicare PECOS PAC ID | 7517476229 |
|---|---|
| Medicare Enrollment ID | O20250604000894 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750185849 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Thulasi Shanmukanathan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669735338 PECOS PAC ID: 3375774284 Enrollment ID: I20250604001061 |
Primary Medical Services Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 26711 Woodward Ave, Ste 108, Huntington Woods, MI 48070 Phone: 248-336-2008 Fax: 248-721-8089 |