Provider Demographics
NPI:1376010140
Name:WEST BLOOMFIELD PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:WEST BLOOMFIELD PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SATYAMURTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTAMRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-202-5589
Mailing Address - Street 1:5800 NANEVA CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2516
Mailing Address - Country:US
Mailing Address - Phone:248-202-5589
Mailing Address - Fax:
Practice Address - Street 1:5800 NANEVA CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2516
Practice Address - Country:US
Practice Address - Phone:248-202-5589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty