| Prasad Mikkilineni Md Pllc | |
|
36975 Five Mile Rd Livonia MI 48154-1871 | |
| (734) 464-0600 | |
| Not Available |
| Full Name | Prasad Mikkilineni Md Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 36975 Five Mile Rd, Livonia, Michigan |
| Authorized Official Name and Position | Irene Martin (BILLER) |
| Authorized Official Contact | 7346742739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prasad Mikkilineni Md Pllc 18576 Shadyside St Livonia MI 48152-3246 Ph: (734) 674-2739 | Prasad Mikkilineni Md Pllc 36975 Five Mile Rd Livonia MI 48154-1871 Ph: (734) 464-0600 |
| NPI Number | 1629582226 |
|---|---|
| Provider Enumeration Date | 11/20/2017 |
| Last Update Date | 11/20/2017 |
| Medicare PECOS PAC ID | 6002175163 |
|---|---|
| Medicare Enrollment ID | O20180117001847 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629582226 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301039936 (Michigan) | Primary |
| Provider Name | Prasad L Mikkilineni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871585562 PECOS PAC ID: 2961502364 Enrollment ID: I20100204000787 |
| Provider Name | Sarah Belinov |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306370879 PECOS PAC ID: 2264790419 Enrollment ID: I20171218002605 |
| Provider Name | Angela Laverne Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295371649 PECOS PAC ID: 9335576230 Enrollment ID: I20200304002338 |
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