Divvela, Jagannadharao

Divvela, Jagannadharao is an individual health care provider with primary practice located at 8244 Metropolitan Pkwy Suite C, Sterling Heights MI 48312-2778. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Divvela, Jagannadharao can be contacted via phone (586) 795-4060.

Contact Information

Primary practice address
8244 Metropolitan Pkwy Suite C Sterling Heights MI 48312-2778
Phone: (586) 795-4060
Fax: (586) 795-5596
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 4301039338 Michigan

Profile Details

NPI number 1093790867
LBN Legal business name Divvela, Jagannadharao
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1093790867 NPPES
Michigan MEDICAID 4587910

Popular Providers