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1780738047 NPI number — RADHIKA K THALLA M.D

NPI Number: 1780738047
Health Care Provider/Practitioner: RADHIKA K THALLA M.D

Information about “1780738047” NPI (RADHIKA K THALLA M.D) exists in 1780738047 in HTML format HTML  |  1780738047 in plain Text format TXT  |  1780738047 in PDF (Portable Document Format) PDF  |  1780738047 in an XML format XML  formats.

NPI Number : 1780738047 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780738047",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THALLA",
    "FirstName": "RADHIKA",
    "MiddleName": "K",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KATAKAM",
    "OtherFirstName": "RADHIKA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "47652 ADRIANA CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CANTON",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48187-1336",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-237-1923",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "27901 WOODWARD AVE",
    "SecondLinePracticeLocationAddress": "SUITE #210",
    "PracticeLocationAddressCityName": "BERKLEY",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48072-0919",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-414-5377",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/23/2007",
    "LastUpdateDate": "09/08/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "4301089117",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RN0300X",
          "TaxonomyName": "Nephrology Physician",
          "LicenseNumber": "4301089117",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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