Basic Information
Provider Information
NPI: 1205955259
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAVARAPU
FirstName: PRATHYUSHA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6717 WHISPERING WOODS DR
Address2:  
City: WEST BLOOMFIELD
State: MI
PostalCode: 483225205
CountryCode: US
TelephoneNumber: 2485921449
FaxNumber:  
Practice Location
Address1: 2799 W GRAND BLVD
Address2:  
City: DETROIT
State: MI
PostalCode: 482022608
CountryCode: US
TelephoneNumber: 3139168144
FaxNumber: 3139164460
Other Information
ProviderEnumerationDate: 03/29/2007
LastUpdateDate: 04/11/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X4301078780MIY Allopathic & Osteopathic PhysiciansHospitalist 
207R00000X4301078780MIN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home