Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301099177 | MI |
NPI | 1003103292 |
---|---|
Provider Name | Harini Erupaka Reddy |
First Address | Royal Oak, MI 48067-1280 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2011 |
Last Update Date | 07/07/2011 |