MEDICARE: FLORENCE SRI-THARAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301065409	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477545101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORENCE SRI-THARAN M.D.

Provider Business Mailing Address
First Line	:	27774 FRANKLIN RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48034-2352
Country	:	US
Telephone Number	:	248-356-5555
Fax Number	:	248-356-5544

Provider Business Practice Location Address
First Line	:	2255 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2444
Country	:	US
Telephone Number	:	313-386-7500
Fax Number	:	313-386-6447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	09/27/2010

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