Provider Demographics
NPI:1831365675
Name:DEVARA, ANUPAMA (MD)
Entity type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:DEVARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE ROAD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:248-359-8660
Practice Address - Street 1:26400 W 12 MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1771
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:248-359-8660
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1182693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630778Medicare PIN