Active NPI
Minu Mathew Puthuppally, FNP-C
- Family Nurse Practitioner
- Troy, MI
National Provider Identifier
1477422152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4704374146
- Practice address
- 2212 Lakeside Dr
Troy, MI 48085-1043 - Phone
- (248) 635-2361
- NPI assigned
- Nov 1, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704374146 | MI | Primary |
Addresses
Primary practice location
2212 Lakeside Dr
Troy, MI 48085-1043
Mailing address
2212 Lakeside Dr
Troy, MI 48085-1043
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704374146 | MI | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761955200000",
"number": "1477422152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2212 LAKESIDE DR",
"city": "TROY",
"state": "MI",
"postal_code": "480851043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2212 LAKESIDE DR",
"city": "TROY",
"state": "MI",
"postal_code": "480851043",
"telephone_number": "248-635-2361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW PUTHUPPALLY",
"first_name": "MINU",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-11-01",
"last_updated": "2025-11-01",
"certification_date": "2025-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704374146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.