MEDICARE: SAILAJA SARVEPALLI M.D.

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	207Q00000X	Family Medicine Physician	4301063171	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1007287	OTHER	MI	MCLAREN
2	20000002628	OTHER	MI	PHYSICIANS HEALTH PLAN
3	0805900382	OTHER	MI	BCBSM
4	0983228	OTHER	MI	HEALTHPLUS COMMERCIAL
5	1006841	OTHER	MI	MCLAREN HEALTH PLAN
6	200000005869	OTHER		PHP COMMERCIAL

General Provider Information

NPI Number	:	1194764878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAILAJA SARVEPALLI M.D.

Provider Business Mailing Address
First Line	:	1021 E MAIN ST
Second Line	:
City	:	EDMORE
State	:	MI
Zip	:	48829-8740
Country	:	US
Telephone Number	:	989-427-5320
Fax Number	:	989-427-8220

Provider Business Practice Location Address
First Line	:	1021 E. MAIN STREET
Second Line	:
City	:	EDMORE
State	:	MI
Zip	:	48829-9737
Country	:	US
Telephone Number	:	989-427-5320
Fax Number	:	989-427-8220

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/12/2012

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