Koneru, Sirisha

Koneru, Sirisha is an individual health care provider with primary practice located at 4646 John R St , Detroit MI 48201-1916. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Koneru, Sirisha can be contacted via phone (248) 894-6393.

Contact Information

Primary practice address
4646 John R St Detroit MI 48201-1916
Phone: (248) 894-6393
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 4301079920 Michigan
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 4301079920 Michigan

Profile Details

NPI number 1578510343
LBN Legal business name Koneru, Sirisha
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 27th, 2006
Last updated Apr 5th, 2021 - about 3 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 1578510343 NPPES
Michigan MEDICAID 104482150
Michigan MEDICAID 104478863
Michigan Other SK079920

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