Divvela, Jagannadharao
Divvela, Jagannadharao is an individual health care provider with primary practice located at 8244 Metropolitan Pkwy Suite C, Sterling Heights MI 48312-2778. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Divvela, Jagannadharao can be contacted via phone (586) 795-4060.Contact Information
Primary practice address
8244 Metropolitan Pkwy Suite C
Sterling Heights MI 48312-2778
Phone: (586) 795-4060
Fax: (586) 795-5596
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 4301039338 | Michigan |
Profile Details
| NPI number | 1093790867 |
|---|---|
| LBN Legal business name | Divvela, Jagannadharao |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 14th, 2005 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093790867 | NPPES |
| Michigan | MEDICAID | 4587910 |
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