Provider Demographics
NPI:1003831173
Name:TRICOUNTY HOSPITALISTS, PLLC
Entity Type:Organization
Organization Name:TRICOUNTY HOSPITALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:MULPURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-595-4758
Mailing Address - Street 1:625 PERRIEN PL
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1132
Mailing Address - Country:US
Mailing Address - Phone:313-595-4758
Mailing Address - Fax:248-265-4082
Practice Address - Street 1:11800 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3472
Practice Address - Country:US
Practice Address - Phone:586-573-5000
Practice Address - Fax:248-265-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061786207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4841598Medicaid
MI1108205692OtherBCBSM
G76181Medicare UPIN
MI4841598Medicaid