MEDICARE: DR. UMA D GORREPATI 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
1	207R00000X	Internal Medicine Physician	4301053629	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1108298481	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1508864240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UMA D GORREPATI MD

Provider Business Mailing Address
First Line	:	6865 RELIABLE PARKWAY
Second Line	:	#6865
City	:	CHICAGO
State	:	IL
Zip	:	60686-0001
Country	:	US
Telephone Number	:	313-831-7005
Fax Number	:	313-831-7002

Provider Business Practice Location Address
First Line	:	4160 JOHN R ST
Second Line	:	SUITE 730
City	:	DETROIT
State	:	MI
Zip	:	48201-2020
Country	:	US
Telephone Number	:	313-831-7005
Fax Number	:	313-831-7002

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/29/2009

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