Provider Demographics
NPI:1922335488
Name:WOMENS LIFE CYCLES OB GYN PC
Entity Type:Organization
Organization Name:WOMENS LIFE CYCLES OB GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JYOTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHANAMETLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-981-2800
Mailing Address - Street 1:42287 CHERRY HILL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1975
Mailing Address - Country:US
Mailing Address - Phone:734-981-2800
Mailing Address - Fax:
Practice Address - Street 1:42287 CHERRY HILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1975
Practice Address - Country:US
Practice Address - Phone:734-981-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079947207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID #