Provider Demographics
NPI:1861509093
Name:JOLEPALEM, NEELAKANTAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELAKANTAM
Middle Name:
Last Name:JOLEPALEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-335-4010
Mailing Address - Fax:248-858-3874
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-335-4010
Practice Address - Fax:248-858-3874
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010427632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI19000659Medicaid
MI260631846OtherBC/BS
MI750910401OtherBCBS
MI750910402OtherBCBS
MI042763OtherLICENSE
MI042763OtherLICENSE
MI042763OtherLICENSE
MIAJ9539492OtherDEA