Provider Demographics
NPI:1164657870
Name:KRISWARI, ARI (MD)
Entity type:Individual
Prefix:
First Name:ARI
Middle Name:
Last Name:KRISWARI
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 1:5333 MCAULEY DRIVE
Mailing Address - Street 2:SUITE 2009
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-0050
Mailing Address - Fax:734-712-0055
Practice Address - Street 1:5333 MCAULEY DRIVE
Practice Address - Street 2:SUITE 2009
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-0050
Practice Address - Fax:734-712-0055
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094157208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0951974OtherBCBS IND
MI1164657870Medicaid
MIN89060006Medicare PIN