Provider Demographics
NPI:1144332800
Name:NICHANAMETLA, JYOTHI R (MD)
Entity type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:R
Last Name:NICHANAMETLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5820 N CANTON CENTER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2679
Mailing Address - Country:US
Mailing Address - Phone:734-981-2800
Mailing Address - Fax:734-981-9028
Practice Address - Street 1:5820 N CANTON CENTER RD STE 120
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2679
Practice Address - Country:US
Practice Address - Phone:734-981-2800
Practice Address - Fax:734-981-9028
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301079947207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII60715Medicare UPIN