Provider Demographics
NPI:1043492226
Name:ADULT MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:ADULT MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-721-7515
Mailing Address - Street 1:16426 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8520
Mailing Address - Country:US
Mailing Address - Phone:248-374-5555
Mailing Address - Fax:
Practice Address - Street 1:34725 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4460
Practice Address - Country:US
Practice Address - Phone:734-721-7515
Practice Address - Fax:734-721-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P27790Medicare PIN