Provider Demographics
NPI:1659406684
Name:R.R. VEMURI, M.D.
Entity Type:Organization
Organization Name:R.R. VEMURI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-284-7563
Mailing Address - Street 1:13225 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1070
Mailing Address - Country:US
Mailing Address - Phone:734-284-4555
Mailing Address - Fax:734-284-6174
Practice Address - Street 1:13225 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1070
Practice Address - Country:US
Practice Address - Phone:734-284-4555
Practice Address - Fax:734-284-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRV050423174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1766589Medicaid
MIA73268Medicare UPIN
MI1766589Medicaid