Provider Demographics
NPI:1639132541
Name:PINNAMARAJU, SRILAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:SRILAKSHMI
Middle Name:
Last Name:PINNAMARAJU
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 1:26850 PROVIDENCE PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1259
Mailing Address - Country:US
Mailing Address - Phone:248-662-4091
Mailing Address - Fax:248-662-0365
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1259
Practice Address - Country:US
Practice Address - Phone:248-662-4091
Practice Address - Fax:248-662-0365
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISP070569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300163180OtherTAX ID
MI4534292Medicaid
MI300163180OtherTAX ID