Provider Demographics
NPI:1396767240
Name:CHILUKURI, SATYA LAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:SATYA
Middle Name:LAKSHMI
Last Name:CHILUKURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35330 NANKIN BLVD
Practice Address - Street 2:SUITE 701
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7223
Practice Address - Country:US
Practice Address - Phone:734-266-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4830235Medicaid
MIH71303Medicare UPIN
MI4830235Medicaid