Provider Demographics
NPI:1336326362
Name:PARVATANENI, AMITHA (MD)
Entity Type:Individual
Prefix:
First Name:AMITHA
Middle Name:
Last Name:PARVATANENI
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 1:28001 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1561
Mailing Address - Country:US
Mailing Address - Phone:586-772-7180
Mailing Address - Fax:586-279-0033
Practice Address - Street 1:28001 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1561
Practice Address - Country:US
Practice Address - Phone:586-772-7180
Practice Address - Fax:586-279-0033
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine