Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 310930 | LA |
Y | 111NI0900X | Internist | 310930 | LA |
NPI | 1003202946 |
---|---|
Provider Name | Rajiv Doddamani |
First Address | Ann Arbor, MI 48106-0995 |
Second Address | Ypsilanti, MI 48197-1014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 08/11/2018 |