Healthcare Provider Details

I. General information

NPI: 1083626501
Provider Name (Legal Business Name): SATYAMURTHY KOTAMRAJU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11457 SHOEMAKER ST
DETROIT MI
48213-3418
US

IV. Provider business mailing address

11457 SHOEMAKER ST
DETROIT MI
48213-3418
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-3435
  • Fax: 313-924-0605
Mailing address:
  • Phone: 313-331-3435
  • Fax: 313-924-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number4301042052
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: