Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301505591 | MI |
Y | 111NI0900X | Internist | 4301505591 | MI |
NPI | 1003299223 |
---|---|
Provider Name | Seetharamprasad Madala |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 30/09/2021 |