Provider Demographics
NPI:1881005114
Name:ALPHA MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:ALPHA MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARI
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DANDAPANTULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-895-2069
Mailing Address - Street 1:25500 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3926
Mailing Address - Country:US
Mailing Address - Phone:313-914-2395
Mailing Address - Fax:313-914-2437
Practice Address - Street 1:26131, SUNBURY CT
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374
Practice Address - Country:US
Practice Address - Phone:248-895-2069
Practice Address - Fax:248-697-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301072495Medicaid