Provider Demographics
NPI:1821276791
Name:ERRA, GOUTHAMI SRAVANTHI (MA)
Entity Type:Individual
Prefix:MRS
First Name:GOUTHAMI
Middle Name:SRAVANTHI
Last Name:ERRA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUIT # 201
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5045
Mailing Address - Country:US
Mailing Address - Phone:248-334-9490
Mailing Address - Fax:248-636-1170
Practice Address - Street 1:44200 WOODWARD AVE.,
Practice Address - Street 2:SUIT # 201
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-334-9490
Practice Address - Fax:248-636-1170
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1601000257OtherAUDIOLOGY