Provider Demographics
NPI:1295205532
Name:LATHA SRIKRISHNA, MD, PC
Entity Type:Organization
Organization Name:LATHA SRIKRISHNA, MD, PC
Other - Org Name:STONEY CREEK PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIKRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-210-5404
Mailing Address - Street 1:441 S LIVERNOIS RD STE 185
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2585
Mailing Address - Country:US
Mailing Address - Phone:248-841-1040
Mailing Address - Fax:248-923-2156
Practice Address - Street 1:441 S LIVERNOIS RD STE 185
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2585
Practice Address - Country:US
Practice Address - Phone:248-963-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care