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General NPI Number Information
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NPI Number | 1376873760
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Entity Type | Organization
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Legal Business Name | SOUMYA MADALA MD PLLC
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 3937 PATIENT CARE WAY STE 102
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City | LANSING
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State | MI
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Zip | 48911-4287
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Country | US
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Telephone | 517-887-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 3937 PATIENT CARE DRIVE #102
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City | LANSING
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State | MI
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Zip | 48911
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Country | US
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Telephone | 517-887-6763
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOUMYA MADALA
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Credential |
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Telephone | 517-339-0322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301085495
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 4301085495
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License Number State | MI
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