Provider Demographics
NPI:1518193259
Name:ATTILI, SREEVALLI (MD)
Entity Type:Individual
Prefix:
First Name:SREEVALLI
Middle Name:
Last Name:ATTILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:11775 TECUMSEH CLINTON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236-9541
Practice Address - Country:US
Practice Address - Phone:517-456-7449
Practice Address - Fax:517-456-6059
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY45132207Q00000X
MI4301102390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK057750Medicare PIN