Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301087670 | MI |
Y | 2084N0402X | Child Neurologist | 2187733 | MI |
NPI | 1104081397 |
---|---|
Provider Name | Dr. Gireesh Velugubanti |
First Address | Shelby Twp, MI 48318-2433 |
Second Address | Ann Arbor, MI 48104-5133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 14/04/2020 |