Healthcare Provider Details

I. General information

NPI: 1609238674
Provider Name (Legal Business Name): SATYAMURTHY KOTAMRAJU MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
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: 248-202-5589
  • Fax:
Mailing address:
  • Phone: 248-202-5589
  • Fax:

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: SATYAMURTHY KOTAMRAJU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-202-5589