Healthcare Provider Details

I. General information

NPI: 1205155512
Provider Name (Legal Business Name): IN-HOUSE GERIATRIC CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 W BIG BEAVER RD STE 310
TROY MI
48084-3409
US

IV. Provider business mailing address

1985 W BIG BEAVER RD STE 310
TROY MI
48084-3409
US

V. Phone/Fax

Practice location:
  • Phone: 248-269-3412
  • Fax:
Mailing address:
  • Phone: 248-269-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301064391
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301064391
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. SRIDEVI YALALA
Title or Position: CEO
Credential: M.D,
Phone: 248-269-3412