Provider Demographics
NPI:1902198443
Name:MUTTAVARAPU, SIRISHA RAO (MD)
Entity Type:Individual
Prefix:MRS
First Name:SIRISHA
Middle Name:RAO
Last Name:MUTTAVARAPU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1600 S CANTON RD, STE 220
Mailing Address - Street 2:IPC - CANTON FAMILY MEDICINE: ST. MARY MERCY HOSPITAL
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1992
Mailing Address - Country:US
Mailing Address - Phone:734-398-8790
Mailing Address - Fax:734-398-8680
Practice Address - Street 1:1600 S CANTON RD, STE 220
Practice Address - Street 2:CIPC - CANTON FAMILY MEDICINE: ST. MARY MERCY HOSPITAL
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1992
Practice Address - Country:US
Practice Address - Phone:734-398-8790
Practice Address - Fax:734-398-8680
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program