Provider Demographics
NPI:1154499697
Name:VUNNAM, SARALA (MD)
Entity Type:Individual
Prefix:
First Name:SARALA
Middle Name:
Last Name:VUNNAM
Suffix:
Gender:F
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:131 KERCHEVAL
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48230
Mailing Address - Country:US
Mailing Address - Phone:313-882-7900
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:131 KERCHEVAL
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48230
Practice Address - Country:US
Practice Address - Phone:313-882-7900
Practice Address - Fax:313-824-3850
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI058426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SV058426OtherCHAMPUS-CHAMPUS
700H262220OtherBLUE CROSS-BLUE CROSS
SV058426OtherCOMMERCIAL-COMMERCIAL NUMBER
MI322380510Medicaid