Provider Demographics
NPI:1316025695
Name:SRIKRISHNA, LATHA (M D)
Entity Type:Individual
Prefix:DR
First Name:LATHA
Middle Name:
Last Name:SRIKRISHNA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 W UNIVERSITY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1872
Mailing Address - Country:US
Mailing Address - Phone:248-963-2191
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0805016261OtherBCBS
MI1316025695Medicaid
MII28355Medicare UPIN