Provider Demographics
NPI:1609043371
Name:DINDIGALLA V RAMANA MD PC
Entity Type:Organization
Organization Name:DINDIGALLA V RAMANA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DINDIGALLA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAMANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-667-9390
Mailing Address - Street 1:1500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1352
Mailing Address - Country:US
Mailing Address - Phone:810-667-9390
Mailing Address - Fax:810-667-9341
Practice Address - Street 1:1500 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1352
Practice Address - Country:US
Practice Address - Phone:810-667-9390
Practice Address - Fax:810-667-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034635208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA74160OtherHAP
MI0445090OtherBCN
MI1002080OtherMCLAREN HEALTH
MI340020639OtherRAILROAD MEDICARE
MI3450902OtherHEALTH PLUS
MIA74160OtherHAP