Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301094696 | MI |
NPI | 1114191129 |
---|---|
Provider Name | Miss Neena Ishwari Marupudi |
First Address | Detroit, MI 48201-2119 |
Second Address | Detroit, MI 48201-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 17/11/2017 |