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NPI Code Detail

MEDICARE: DR. JYOTHSNA YALAVARTHI MD

MEDICARE: DR. JYOTHSNA YALAVARTHI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician35079536OH
2207R00000XInternal Medicine Physician4301097794MI
3208M00000XHospitalist Physician4301097794MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003811662
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JYOTHSNA YALAVARTHI MD
Provider Business Mailing Address
First Line : 36123 SCHOOLCRAFT RD
Second Line :
City : LIVONIA
State : MI
Zip : 48150-1216
Country : US
Telephone Number : 734-464-0887
Fax Number : 734-402-0254
Provider Business Practice Location Address
First Line : 28050 GRAND RIVER AVE
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48336-5919
Country : US
Telephone Number : 734-464-0887
Fax Number : 734-402-0254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 07/29/2015

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