Provider Demographics
NPI:1447399266
Name:PALAKURTHI, PLLC
Entity Type:Organization
Organization Name:PALAKURTHI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKASHMI
Authorized Official - Middle Name:C
Authorized Official - Last Name:PALAKURTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-674-7316
Mailing Address - Street 1:1777 AXTELL DR
Mailing Address - Street 2:#109
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4404
Mailing Address - Country:US
Mailing Address - Phone:248-649-2626
Mailing Address - Fax:248-649-5284
Practice Address - Street 1:1777 AXTELL DR
Practice Address - Street 2:#109
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4404
Practice Address - Country:US
Practice Address - Phone:248-649-2626
Practice Address - Fax:248-649-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N86250Medicare PIN