Provider Demographics
NPI:1750686143
Name:INTEGRATED HOME CLINIC
Entity Type:Organization
Organization Name:INTEGRATED HOME CLINIC
Other - Org Name:INTEGRATED HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:SAILAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDDIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-809-6402
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:240
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3709
Mailing Address - Country:US
Mailing Address - Phone:248-809-6402
Mailing Address - Fax:
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:240
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3709
Practice Address - Country:US
Practice Address - Phone:248-809-6402
Practice Address - Fax:248-809-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075965261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health