Provider Demographics
NPI:1821463175
Name:PRATIMA BOINEPALLI MD, P.L.L.C
Entity Type:Organization
Organization Name:PRATIMA BOINEPALLI MD, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOINEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-347-4660
Mailing Address - Street 1:1901 BELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5908
Mailing Address - Country:US
Mailing Address - Phone:517-347-4660
Mailing Address - Fax:
Practice Address - Street 1:1901 BELWOOD DR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5908
Practice Address - Country:US
Practice Address - Phone:517-347-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085879261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care