# SOUMYA MADALA MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376873760
- **Authorized official:** SOUMYA MADALA (OWNER)
- **Authorized official phone:** (517) 339-0322

## Contact information

- **Practice address:** 3937 PATIENT CARE WAY STE 102, LANSING, MI 48911-4287
- **Practice address phone:** (517) 887-6763
- **Mailing address:** 3937 PATIENT CARE DRIVE, \#102, LANSING, MI 48911
- **Mailing address phone:** (517) 887-6763

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 4301085495 | MI | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | 4301085495 | MI | Yes |

## Other

- **Enumeration date:** 01/06/2010
- **Last updated:** 02/18/2010