Healthcare Provider Details

I. General information

NPI: 1053374942
Provider Name (Legal Business Name): BABYSAROJINI CHIRUMAMILLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST
DETROIT MI
48201-1916
US

IV. Provider business mailing address

4646 JOHN R ST
DETROIT MI
48201-1916
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-1000
  • Fax: 313-576-1091
Mailing address:
  • Phone: 313-576-1000
  • Fax: 313-576-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301060196
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: