=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609043371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DINDIGALLA V RAMANA MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2008
-----------------------------------------------------
Last Update Date | 02/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 N MAIN STREET
-----------------------------------------------------
City | LAPEER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48446-1352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-667-9390
-----------------------------------------------------
Fax | 810-667-9341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 N MAIN ST
-----------------------------------------------------
City | LAPEER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48446-1352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-667-9390
-----------------------------------------------------
Fax | 810-667-9341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DINDIGALLA V RAMANA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 810-667-9390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 4301034635
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------