Healthcare Provider Details

I. General information

NPI: 1942829262
Provider Name (Legal Business Name): AKHILA LATTUPALLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44344 DEQUINDRE RD STE 510
STERLING HEIGHTS MI
48314-1042
US

IV. Provider business mailing address

44344 DEQUINDRE RD STE 510
STERLING HEIGHTS MI
48314-1042
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-6300
  • Fax: 586-323-6331
Mailing address:
  • Phone: 586-323-6300
  • Fax: 586-323-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301509910
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: