1902198443 NPI number — MRS. SIRISHA RAO MUTTAVARAPU M.D.

Table of content: MRS. SIRISHA RAO MUTTAVARAPU M.D. (NPI 1902198443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902198443 NPI number — MRS. SIRISHA RAO MUTTAVARAPU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUTTAVARAPU
Provider First Name:
SIRISHA
Provider Middle Name:
RAO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902198443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 S CANTON RD, STE 220
Provider Second Line Business Mailing Address:
IPC - CANTON FAMILY MEDICINE: ST. MARY MERCY HOSPITAL
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48188-1992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-398-8790
Provider Business Mailing Address Fax Number:
734-398-8680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 S CANTON RD, STE 220
Provider Second Line Business Practice Location Address:
CIPC - CANTON FAMILY MEDICINE: ST. MARY MERCY HOSPITAL
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48188-1992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-398-8790
Provider Business Practice Location Address Fax Number:
734-398-8680
Provider Enumeration Date:
05/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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