Provider Demographics
NPI:1275739351
Name:HARANATH POLICHERLA M.D. PC
Entity Type:Organization
Organization Name:HARANATH POLICHERLA M.D. PC
Other - Org Name:POINTE NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARANATH
Authorized Official - Middle Name:
Authorized Official - Last Name:POLICHERLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD ACP
Authorized Official - Phone:313-882-0640
Mailing Address - Street 1:20160 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1822
Mailing Address - Country:US
Mailing Address - Phone:313-882-0640
Mailing Address - Fax:313-882-3106
Practice Address - Street 1:20160 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1822
Practice Address - Country:US
Practice Address - Phone:313-882-0640
Practice Address - Fax:313-882-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIHP050806OtherBLUE CROSS PIN#
MI0M16880Medicare PIN