Provider Demographics
NPI:1689373086
Name:GUJJA, VEERAGOPAL
Entity Type:Individual
Prefix:
First Name:VEERAGOPAL
Middle Name:
Last Name:GUJJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POWELL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-8645
Mailing Address - Country:US
Mailing Address - Phone:517-266-1481
Mailing Address - Fax:
Practice Address - Street 1:100 POWELL DR STE 2
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-8645
Practice Address - Country:US
Practice Address - Phone:517-266-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist