Provider Demographics
NPI:1497106603
Name:POTUGARI, BINDU (MD,)
Entity Type:Individual
Prefix:
First Name:BINDU
Middle Name:
Last Name:POTUGARI
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 1:2800 W GRAND BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:313-916-4989
Practice Address - Street 1:2800 W GRAND BLVD FL 3
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2610
Practice Address - Country:US
Practice Address - Phone:313-556-8820
Practice Address - Fax:313-916-4989
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301507005207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty