Healthcare Provider Details

I. General information

NPI: 1033592936
Provider Name (Legal Business Name): 4-SERV FAMILY MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51619 TEN MILE RD
SOUTH LYON MI
48178
US

IV. Provider business mailing address

24351 BELLINGHAM DR
NOVI MI
48374-2534
US

V. Phone/Fax

Practice location:
  • Phone: 248-437-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301095478
License Number StateMI

VIII. Authorized Official

Name: SRIKAR REDDY
Title or Position: OWNER
Credential: M.D.
Phone: 614-625-0248