| Atul Medavaram, MD | |
|
6245 Inkster Rd, Garden City, MI 48135-4001 | |
| (734) 458-4486 | |
| Not Available |
| Full Name | Atul Medavaram |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Experience | 7 Years |
| Location | 6245 Inkster Rd, Garden City, Michigan |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487215638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4351044756 (Michigan) | Secondary |
| 208M00000X | Hospitalist | 036162089 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Memorial Hospital | Belleville, IL | Hospital |
| St Joseph Hospital | Bangor, ME | Hospital |
| Ascension All Saints Hospital | Racine, WI | Hospital |
| Ascension Columbia St Mary's Hospital Milwaukee | Milwaukee, WI | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Fairview Heights Medical Group Sc | 6800784083 | 386 |
| Apogee Medical Group Maine Pc | 8527415462 | 32 |
| Columbia St Marys Hospital Milwaukee Inc | 5890604722 | 299 |
| Ascension Medical Group-southeast Wisconsin Inc | 8628980943 | 505 |
| Entity Name | Fairview Heights Medical Group Sc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1679503668 PECOS PAC ID: 6800784083 Enrollment ID: O20040309000650 |
| Entity Name | 24 On Physicians Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1346480431 PECOS PAC ID: 5698688141 Enrollment ID: O20090609000389 |
| Entity Name | Cep America-illinois Hospitalists, Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1841613403 PECOS PAC ID: 3274765904 Enrollment ID: O20140411001788 |
| Mailing Address | Practice Location Address |
|---|---|
| Atul Medavaram, MD 6245 Inkster Rd, Garden City, MI 48135-4001 Ph: () - | Atul Medavaram, MD 6245 Inkster Rd, Garden City, MI 48135-4001 Ph: (734) 458-4486 |