Healthcare Provider Details

I. General information

NPI: 1871913350
Provider Name (Legal Business Name): ROHAN KRISHNA POLICHERLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ST. ANTOINE 6C UNIVERSITY HEALTH CENTER
DETROIT MI
48201
US

IV. Provider business mailing address

921 CANTERBURY RD
GROSSE POINTE WOODS MI
48236-1252
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-5009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: