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General NPI Number Information
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NPI Number | 1760662951
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Entity Type | Organization
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Legal Business Name | SIRISHA KONERU, M.D, P.C.
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 43171 DALCOMA DR
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6307
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Country | US
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Telephone | 586-263-9772
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Fax |
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Provider Business Mailing Address
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Address Line | 1762 WYNGATE DR
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City | TROY
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State | MI
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Zip | 48098-6545
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Country | US
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Telephone | 248-888-8410
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIRISHA KONERU
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Credential | M.D
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Telephone | 248-888-8410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301079920
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License Number State | MI
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