Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301085495 | MI |
N | 111NI0900X | Internist | 4301085495 | MI |
Y | 207RS0012X | Sleep Medicine | 4301085495 | MI |
NPI | 1043334527 |
---|---|
Provider Name | Dr. Soumya Chowdary Madala |
First Address | Grand Rapids, MI 49503-4328 |
Second Address | Grand Rapids, MI 49503-4597 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 03/12/2021 |