| Sudha Nannapaneni Md Pllc | |
|
18285 E 10 Mile Rd Ste 120 Roseville MI 48066-5806 | |
| (586) 771-4830 | |
| Not Available |
| Full Name | Sudha Nannapaneni Md Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 18285 E 10 Mile Rd Ste 120, Roseville, Michigan |
| Authorized Official Name and Position | Sudha Nannapaneni (OWNER) |
| Authorized Official Contact | 3133004083 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sudha Nannapaneni Md Pllc 18285 E 10 Mile Rd Ste 120 Roseville MI 48066-5806 Ph: (586) 771-4830 | Sudha Nannapaneni Md Pllc 18285 E 10 Mile Rd Ste 120 Roseville MI 48066-5806 Ph: (586) 771-4830 |
| NPI Number | 1437482981 |
|---|---|
| Provider Enumeration Date | 09/16/2009 |
| Last Update Date | 10/07/2011 |
| Medicare PECOS PAC ID | 9234254418 |
|---|---|
| Medicare Enrollment ID | O20100910000775 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437482981 | NPI | - | NPPES |
| 104290526 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301070308 (Michigan) | Primary |
| Provider Name | Sudha Nannapaneni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720166713 PECOS PAC ID: 2062537244 Enrollment ID: I20100910000765 |
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