MEDICARE: SITA RAM KAURA 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	207Q00000X	Family Medicine Physician	4301038595	MI

General Provider Information

NPI Number	:	1942351820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SITA RAM KAURA MD

Provider Business Mailing Address
First Line	:	14797 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2507
Country	:	US
Telephone Number	:	734-281-9950
Fax Number	:	734-281-4998

Provider Business Practice Location Address
First Line	:	14797 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2507
Country	:	US
Telephone Number	:	734-281-9950
Fax Number	:	734-281-4998

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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