Basic Information
| Provider Information | |||||||||
| NPI: | 1538130224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VATTIPALLY | ||||||||
| FirstName: | VENKATRAMANA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 N CENTER RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486037920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897539000 | ||||||||
| FaxNumber: | 9897534024 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 N CENTER RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486037920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897539000 | ||||||||
| FaxNumber: | 9897534024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 06/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 4301072639 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 4301072639 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4786020 | 05 | MI | MEDICAID |