=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821196551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED GERIATRIC SERVICES P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 02/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 S ADAMS RD STE 243
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48009-6913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-220-1148
-----------------------------------------------------
Fax | 248-220-1151
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2328 LIVERNOIS RD STE 1060
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48083-1662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-220-1148
-----------------------------------------------------
Fax | 248-220-1151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | SRINIVAS NALLANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-220-1148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------