Gaddam, Shailaja

Gaddam, Shailaja is an individual health care provider with primary practice located at 2799 W Grand Blvd , Detroit MI 48202. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is her primary health care specialty. Gaddam, Shailaja can be contacted via phone (800) 653-6568.

Contact Information

Primary practice address
2799 W Grand Blvd Detroit MI 48202
Phone: (800) 653-6568
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 4301084980 Michigan
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 4301084980 Michigan

Profile Details

NPI number 1316933971
LBN Legal business name Gaddam, Shailaja
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2005
Last updated Dec 13th, 2018 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316933971 NPPES
Michigan MEDICAID 4754518

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