Basic Information
| Provider Information | |||||||||
| NPI: | 1710142732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UPPALA | ||||||||
| FirstName: | PHANIBINDU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 FRANK LLOYD WRIGHT DR. | ||||||||
| Address2: | PO BOX 0446 LOBBY J | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347476766 | ||||||||
| FaxNumber: | 7342223100 | ||||||||
| Practice Location | |||||||||
| Address1: | 870 E ARKONA RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481609770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344392429 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301095128 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.