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Organization
SAMYUKTHA RANI MADISHETTY MD PC
Active
Organization
SAMYUKTHA RANI MADISHETTY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMYUKTHA RANI MADISHETTY MD (OWNER)
(313) 561-3000
Entity
Organization
Contact information
Practice address
24100 OXFORD ST, DEARBORN, MI 48124
(313) 561-3000
(313) 561-4831
Mailing address
24100 OXFORD ST, DEARBORN, MI 48124-2481
(313) 561-3000
(313) 561-4831
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301080548
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110H237950
BCBS GROUP
MI
05
—
1487867644
—
MI
01
—
DH0704
RAILROAD MEDICARE GROUP
MI
01
—
I46399
HAP
MI
Enumeration date
05/07/2007
Last updated
12/11/2020
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