Healthcare Provider Details

I. General information

NPI: 1417015629
Provider Name (Legal Business Name): LALITHA RAMAMOORTHY MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28455 HAGGERTY RD
NOVI MI
48377-2982
US

IV. Provider business mailing address

21884 MERIDIAN LN
NOVI MI
48375-4943
US

V. Phone/Fax

Practice location:
  • Phone: 248-553-0050
  • Fax:
Mailing address:
  • Phone: 248-767-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: