Healthcare Provider Details

I. General information

NPI: 1922335488
Provider Name (Legal Business Name): WOMENS LIFE CYCLES OB GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 N CANTON CENTER RD STE 120
CANTON MI
48187-2679
US

IV. Provider business mailing address

42287 CHERRY HILL RD SUITE D
CANTON MI
48188-1975
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-2800
  • Fax:
Mailing address:
  • Phone: 734-981-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301079947
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JYOTHI NICHANAMETLA
Title or Position: OWNER
Credential: M.D.
Phone: 734-981-2800