Revanth Mopuru

NPI 1114371275 · on the registry since 2016 · sole proprietor

Practice

Address: 2815 Northwind Dr
East Lansing, MI 48823
Phone: (517) 332-0817
Organisation at this address: East Lansing Opco Llc
East Lansing Health Care Center, Inc.
Progressive Care Medical Group Of Mi, Pllc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 3

Registry record

Primary taxonomy: 225100000X
225100000X
Licence states on file: MI
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2016-04-14

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan