Healthcare Provider Details

I. General information

NPI: 1033347646
Provider Name (Legal Business Name): MUNE GOWDA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY SUITE 125
NOVI MI
48374-1213
US

IV. Provider business mailing address

26850 PROVIDENCE PKWY STE 125
NOVI MI
48374-1253
US

V. Phone/Fax

Practice location:
  • Phone: 248-305-8400
  • Fax:
Mailing address:
  • Phone: 248-305-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMG037325
License Number StateMI

VIII. Authorized Official

Name: DR. MUNE GOWDA
Title or Position: OWNER
Credential: M.D.
Phone: 248-305-8400