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NPI Code Detail

MEDICARE: DR. LATHA SRIKRISHNA M. D.

MEDICARE: DR. LATHA SRIKRISHNA 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
1207Q00000XFamily Medicine Physician4301081098MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10805016261OTHERMIBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316025695
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LATHA SRIKRISHNA M. D.
Provider Business Mailing Address
First Line : 1135 W UNIVERSITY DR STE 220
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-1872
Country : US
Telephone Number : 248-963-2191
Fax Number :
Provider Business Practice Location Address
First Line : 441 S LIVERNOIS RD STE 185
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-2585
Country : US
Telephone Number : 248-963-2191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 12/08/2019

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