Provider Demographics
NPI:1144342320
Name:BARODAWALLA, RUMANA ANIS (MD)
Entity type:Individual
Prefix:MRS
First Name:RUMANA
Middle Name:ANIS
Last Name:BARODAWALLA
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 1:709 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2207
Mailing Address - Country:US
Mailing Address - Phone:989-772-7774
Mailing Address - Fax:989-772-7220
Practice Address - Street 1:709 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2207
Practice Address - Country:US
Practice Address - Phone:989-772-7774
Practice Address - Fax:989-772-7220
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI421560109OtherTAX IDENTIFICATION NUMBER
MI3503700851OtherBCBSM
MI4458314Medicaid
MI421560109OtherTAX IDENTIFICATION NUMBER