Provider Demographics
NPI:1508864240
Name:GORREPATI, UMA D (MD)
Entity Type:Individual
Prefix:DR
First Name:UMA
Middle Name:D
Last Name:GORREPATI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6865 RELIABLE PARKWAY
Mailing Address - Street 2:#6865
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:313-831-7005
Mailing Address - Fax:313-831-7002
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 730
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-831-7005
Practice Address - Fax:313-831-7002
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2009-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4390989Medicaid
MI1108298481OtherBCBS
MI4390989Medicaid
MI0N58420001Medicare PIN