Healthcare Provider Details

I. General information

NPI: 1316952773
Provider Name (Legal Business Name): GOVARDHANA RAO BANDLAMUDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG RD
BATTLE CREEK MI
49015-1014
US

IV. Provider business mailing address

5500 ARMSTRONG RD
BATTLE CREEK MI
49015-1014
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax:
Mailing address:
  • Phone: 269-966-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA92241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: