Provider Demographics
NPI:1497175087
Name:CHITTIPROL, SEETHARAMAIAH (PHD,DABCC,NRCC)
Entity Type:Individual
Prefix:DR
First Name:SEETHARAMAIAH
Middle Name:
Last Name:CHITTIPROL
Suffix:
Gender:M
Credentials:PHD,DABCC,NRCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HURLEY PLAZA
Mailing Address - Street 2:HURLEY MEDICALCENTER
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:858-699-6901
Mailing Address - Fax:810-262-7082
Practice Address - Street 1:ONE HURLEY PLAZA
Practice Address - Street 2:HURLEY MEDICAL CENTER
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:858-699-6901
Practice Address - Fax:810-262-7082
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1110247ZC0005X
DC3827247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC316762005681OtherDRIVERS LICENCE