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Organization
PRASAD MIKKILINENI MD
Active
Organization
PRASAD MIKKILINENI MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IRENE LYNN MARTIN (BILLER)
(734) 675-4273
Entity
Organization
Contact information
Practice address
36975 FIVE MILE RD, LIVONIA, MI 48154-1871
(734) 464-0600
Mailing address
18576 SHADYSIDE ST, LIVONIA, MI 48152-3246
(734) 674-2739
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301039936
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
4301039936
MI
Other
Enumeration date
11/19/2017
Last updated
11/19/2017
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