Provider Demographics
NPI:1659303766
Name:YERRA, KAMESHWARI (MD)
Entity type:Individual
Prefix:DR
First Name:KAMESHWARI
Middle Name:
Last Name:YERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAMESHWARI
Other - Middle Name:
Other - Last Name:DASARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:36040 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4239
Mailing Address - Country:US
Mailing Address - Phone:586-939-9160
Mailing Address - Fax:586-939-0162
Practice Address - Street 1:36040 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4239
Practice Address - Country:US
Practice Address - Phone:586-939-9160
Practice Address - Fax:586-939-0162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077692207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics