Provider Demographics
NPI:1023120532
Name:SASIKALA & KOTESWARA RAO VEMURI MD PC
Entity type:Organization
Organization Name:SASIKALA & KOTESWARA RAO VEMURI MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SASIKALA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-9300
Mailing Address - Street 1:1397 S LINDEN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4194
Mailing Address - Country:US
Mailing Address - Phone:810-720-9300
Mailing Address - Fax:
Practice Address - Street 1:1397 S LINDEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4194
Practice Address - Country:US
Practice Address - Phone:810-720-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N83380Medicare PIN