Provider Demographics
NPI:1821140609
Name:SARADA GULLAPALLI, M.D.,PLLC
Entity Type:Organization
Organization Name:SARADA GULLAPALLI, M.D.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARADA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-350-9400
Mailing Address - Street 1:20307 W 12 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5407
Mailing Address - Country:US
Mailing Address - Phone:248-350-9400
Mailing Address - Fax:248-350-9401
Practice Address - Street 1:20307 W 12 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5407
Practice Address - Country:US
Practice Address - Phone:248-350-9400
Practice Address - Fax:248-350-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F327480OtherBCBS GROUP ID