Active NPI
Manjunath Bagewadi Ellur
- Pharmacist
- Highland Park, MI
National Provider Identifier
1952898363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302037567
- Practice address
- 13111 Woodward Ave
Highland Park, MI 48203-3781 - Phone
- (313) 865-9900
- NPI assigned
- Apr 20, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302037567 | MI | Primary |
Addresses
Primary practice location
13111 Woodward Ave
Highland Park, MI 48203-3781
Mailing address
13111 Woodward Ave
Highland Park, MI 48203-3781
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302037567 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524182400000",
"number": "1952898363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13111 WOODWARD AVE",
"city": "HIGHLAND PARK",
"state": "MI",
"postal_code": "482033781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13111 WOODWARD AVE",
"city": "HIGHLAND PARK",
"state": "MI",
"postal_code": "482033781",
"telephone_number": "313-865-9900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGEWADI ELLUR",
"first_name": "MANJUNATH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-20",
"last_updated": "2018-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302037567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Highland Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.