MEDICARE: DR. NEELIMA KATTA DDS

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
1	122300000X	Dentist	56543	CA

General Provider Information

NPI Number	:	1184807711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEELIMA KATTA DDS

Provider Business Mailing Address
First Line	:	21700 COLONY PARK CIR APT 205
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-1682
Country	:	US
Telephone Number	:	248-351-0879
Fax Number	:

Provider Business Practice Location Address
First Line	:	21700 COLONY PARK CIR APT 205
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-1682
Country	:	US
Telephone Number	:	248-351-0879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	10/24/2013

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