=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043492226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADULT MEDICAL CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 11/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34725 PALMER RD
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48186-4460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-721-7515
-----------------------------------------------------
Fax | 734-721-4242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16426 SHERWOOD LN
-----------------------------------------------------
City | NORTHVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48168-8520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-374-5555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SATYA CHILUKURI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 734-721-7515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 4301073762
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------