Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301093977 | MI |
Y | 111NI0900X | Internist | 4301093977 | MI |
NPI | 1003048687 |
---|---|
Provider Name | Vidya Sagar Kollu |
First Address | Flint, MI 48532-3638 |
Second Address | Flint, MI 48532-3604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2009 |
Last Update Date | 17/08/2009 |