Provider Demographics
NPI:1033263884
Name:YALAMANCHI, RAMALINGESWARA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMALINGESWARA
Middle Name:R
Last Name:YALAMANCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1065
Mailing Address - Country:US
Mailing Address - Phone:734-282-7353
Mailing Address - Fax:734-282-8178
Practice Address - Street 1:13300 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1065
Practice Address - Country:US
Practice Address - Phone:734-282-7353
Practice Address - Fax:734-282-8178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI037908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382334954OtherCIGNA HEALTH CARE
MI63847AOtherHAP
MI382334954OtherUNITED HEALTH CARE
MI382334954OtherAETNA
MI0827487OtherBCBS
MA2102832Medicaid
MI63847AOtherHAP
MI382334954OtherAETNA