Healthcare Provider Details

I. General information

NPI: 1023121910
Provider Name (Legal Business Name): MUNE GOWDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE STE B129
NOVI MI
48374
US

IV. Provider business mailing address

47601 GRAND RIVER AVE STE B129
NOVI MI
48374
US

V. Phone/Fax

Practice location:
  • Phone: 248-305-8400
  • Fax: 348-305-5880
Mailing address:
  • Phone: 248-305-8400
  • Fax: 348-305-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMG037325
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMG037325
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMG037325
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: