Basic Information
| Provider Information | |||||||||
| NPI: | 1952890881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURTHY | ||||||||
| FirstName: | ANAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 HOSPITAL DRIVE | ||||||||
| Address2: | G1218 TOWSLEY, SPC 5222 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342326048 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DR. | ||||||||
| Address2: | C213 MEDINN, SPC 5831 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349365950 | ||||||||
| FaxNumber: | 7342325015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2018 | ||||||||
| LastUpdateDate: | 07/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 103613 | CA | N | Dental Providers | Dentist | 390200000X | 4351048786 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 2951000797 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.