Healthcare Provider Details

I. General information

NPI: 1861747180
Provider Name (Legal Business Name): DHUPATI SITARAM, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W OUTER DR SUITE 300
DETROIT MI
48235-2614
US

IV. Provider business mailing address

6001 W OUTER DR SUITE 300
DETROIT MI
48235-2614
US

V. Phone/Fax

Practice location:
  • Phone: 313-342-6100
  • Fax: 313-342-6101
Mailing address:
  • Phone: 313-342-6100
  • Fax: 313-342-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number037731
License Number StateMI

VIII. Authorized Official

Name: DR. DHUPATI SITARAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 313-342-6100